1
|
Ibrahim H, Lachkar AA, Bidault V, Delcour C, Paye-Jaouen A, Peycelon M, El-Ghoneimi A. Genito-urinary Reconstruction in Female Children With Congenital Adrenal Hyperplasia: Favorable Surgical Outcomes can be Achieved by Contemporary Techniques and a Dedicated Multidisciplinary Management. J Pediatr Surg 2024:S0022-3468(24)00310-5. [PMID: 38902168 DOI: 10.1016/j.jpedsurg.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Congenital adrenal hyperplasia (CAH) is the most common cause of genital atypia in females. A dedicated multidisciplinary team (MDT) should be included for an optimal management. Here, we aimed to review our surgical experience and to assess long-term urinary, gynecological and endocrine outcomes after primary genitoplasty in this specific cohort. METHODS Patients born with CAH and who underwent feminizing genitoplasty in our institution were retrospectively identified (2001-2021). We analyzed patients' characteristics, intraoperative details, and postoperative urinary, gynecological, and endocrine outcomes. RESULTS Forty patients were included and followed-up for a median (IQR) time of 7 (1-19) years. Thirty-eight (95%) had 21-hydroxylase deficiency. After multidisciplinary decision and written consent from patient and/or family, a single-stage reconstructive surgery was performed at a median age of 10 (3-165) months. Median length of hospital stay was 5 (1-7) days. Procedures were: PUM (N = 35 (87.5%)), TUM (N = 3 (7.5%)), urogenital mobilization was unnecessary in 2 (5%). Reduction clitoroplasty was done in 33 (82.5%) patients. Only 3 (7.5%) experienced significant Clavien-Dindo complications requiring additional surgery during the follow-up period. Recurrent urinary tract infections (UTI) occurred in 6 (15%), one required ureteric reimplantation for symptomatic high-grade vesicoureteric reflux. All patients over 3 years were toilet-trained without incontinence. Severe vaginal stenosis occurred in 1 (2.5%) patient. In patients who achieved puberty, 6/9 had vaginal calibration at a median age of 17.3 (16-21) years without detected stenosis. One (2.5%) had major hypertrophy of the right labia minora requiring labiaplasty. Nine (22.5%) reached puberty. Two (5%) patients developed acne/hirsutism. Short stature was noted in 11 (27.5%) and obesity in 18 (45%). CONCLUSION Based on our contemporary series, genitourinary reconstructive surgery for female patients born with CAH is technically feasible and safe with a low complication rate. A regular follow-up with a MDT to assess long-term complications is necessary, and it is vital to inform patients and families about the different management options with all the risks and benefits of surgery. TYPE OF THE STUDY original research, clinical research. LEVEL OF EVIDENCE Level 3 retrospective study.
Collapse
Affiliation(s)
- Hussein Ibrahim
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Université Paris Cité, Paris, France; Reference Expert Center for Rare Diseases « Maladies Endocriniennes de la Croissance et du Développement » (CRESCENDO), Paris, France; Pediatric Surgery Unit, Assiut University Children Hospital, Assiut, Egypt
| | - Amane-Allah Lachkar
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Université Paris Cité, Paris, France; Reference Expert Center for Rare Diseases « Maladies Endocriniennes de la Croissance et du Développement » (CRESCENDO), Paris, France
| | - Valeska Bidault
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Université Paris Cité, Paris, France; Reference Expert Center for Rare Diseases « Maladies Endocriniennes de la Croissance et du Développement » (CRESCENDO), Paris, France
| | - Clemence Delcour
- Department of Gynecology, Robert-Debré University Hospital, APHP, Université Paris Cité, Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Université Paris Cité, Paris, France; Reference Expert Center for Rare Diseases « Maladies Endocriniennes de la Croissance et du Développement » (CRESCENDO), Paris, France
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Université Paris Cité, Paris, France; Reference Expert Center for Rare Diseases « Maladies Endocriniennes de la Croissance et du Développement » (CRESCENDO), Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Université Paris Cité, Paris, France; Reference Expert Center for Rare Diseases « Maladies Endocriniennes de la Croissance et du Développement » (CRESCENDO), Paris, France.
| |
Collapse
|
2
|
Hegarty P, Smith A. Public understanding of intersex: an update on recent findings. Int J Impot Res 2023; 35:72-77. [PMID: 35031713 PMCID: PMC9935380 DOI: 10.1038/s41443-021-00485-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/17/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022]
Abstract
Surgical interventions on infants with intersex characteristics are considered justified by some on the grounds that they carry a high risk of intolerable stigma. However, public understanding of intersex and its medicalization are under-researched. We review recent qualitative and quantitative studies of the understandings of intersex and its medicalization among people who have no particular professional or public experience of intersex. First, such laypeople reason about clinical dilemmas by drawing on values in similar ways as expert healthcare professionals do. Second, laypeople can over-estimate the utility of current 'umbrella terms,' including intersex, for people with direct familial experience of intersex. Third, beliefs about good and bad effects of medical intervention are affected by framing intersex as either a medical condition or the natural basis for a social identity. Fourth, sexual identity is the best evidenced predictor of opinions about early surgical intervention and its legal limitation on human rights grounds. We argue that possible stigmatizing reactions from the public may not be a solid basis on which to justify early surgical intervention on intersex characteristics.
Collapse
|
3
|
De Clercq E, Starke G, Rost M. "Waking up" the sleeping metaphor of normality in connection to intersex or DSD: a scoping review of medical literature. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2022; 44:50. [PMID: 36282442 PMCID: PMC9596528 DOI: 10.1007/s40656-022-00533-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
The aim of the study is to encourage a critical debate on the use of normality in the medical literature on DSD or intersex. For this purpose, a scoping review was conducted to identify and map the various ways in which "normal" is used in the medical literature on DSD between 2016 and 2020. We identified 75 studies, many of which were case studies highlighting rare cases of DSD, others, mainly retrospective observational studies, focused on improving diagnosis or treatment. The most common use of the adjective normal was in association with phenotypic sex. Overall, appearance was the most commonly cited criteria to evaluate the normality of sex organs. More than 1/3 of the studies included also medical photographs of sex organs. This persistent use of normality in reference to phenotypic sex is worrisome given the long-term medicalization of intersex bodies in the name of a "normal" appearance or leading a "normal" life. Healthcare professionals should be more careful about the ethical implications of using photographs in publications given that many intersex persons describe their experience with medical photography as dehumanizing.
Collapse
Affiliation(s)
- Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
- Institute of Biomedical Ethics and History of Medicine, University of Zürich, Winterthurerstrasse 30, 8006 Zurich, Switzerland
| | - Georg Starke
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
- College of Humanities, École Polytechnique Fédérale de Lausanne, Rte Cantonale, 1015 Lausanne, Switzerland
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| |
Collapse
|
4
|
Long CJ, Van Batavia J, Wisniewski AB, Aston CE, Baskin L, Cheng EY, Lakshmanan Y, Meyer T, Kropp B, Palmer B, Nokoff NJ, Paradis A, VanderBrink B, Scott Reyes KJ, Yerkes E, Poppas DP, Mullins LL, Kolon TF. Post-operative complications following masculinizing genitoplasty in moderate to severe genital atypia: results from a multicenter, observational prospective cohort study. J Pediatr Urol 2021; 17:379-386. [PMID: 33726972 PMCID: PMC8713352 DOI: 10.1016/j.jpurol.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. A phenotype of severe genital atypia in patients raised as male is a relatively rare occurrence and standards for management are lacking. Decision making for early surgical planning in these rare cases includes, but is not limited to, degree of atypia, location of testes, and presence of Mϋllerian remnants. In this study we describe surgical approaches and short-term outcomes for masculinizing genitoplasty in moderate to severe genital atypia in young patients raised male, for whom parents opted for early surgery. METHODS This NIH-sponsored study is an ongoing, observational, multicenter investigation assessing medical, surgical and psychological outcomes in children and their parents affected by atypical genitalia due to DSD. Participants were prospectively enrolled from 12 children's hospitals across the United States that specialize in DSD care. Criteria for child enrollment were a Quigley score of 3-6 in those with a 46, XY or 45,X/46, XY chromosome complement, age <3 years with no previous genitoplasty; patients were included independent of whether genitoplasty was performed. Cosmesis was graded according to a 4-point Likert scale and complications per the Clavian-Dindo classification. RESULTS Of the 31 participants, 30 underwent hypospadias repair and 1 patient did not undergo a genitoplasty procedure. The majority of participants (22) received a staged hypospadias repair. Seventeen complications were identified in 12 of the 31 children (41%) at 12 months of follow up. Glans dehiscence and urethrocutaneous fistula were the most common complications. Orchiopexy was performed in 14 (44%) and streak gonads were removed in 4 (13%) participants. Both parents and surgeons reported improved cosmesis after surgery when compared to baseline. CONCLUSION Genitoplasty was chosen by parents for the majority of children eligible for study. No single surgical approach for masculinizing moderate to severe genital ambiguity in young patients with 46, XY or 45,X/46, XY DSD was adopted by all surgeons. Complications occurred in 41% of those who underwent genitoplasty for severe hypospadias. Overall, appearance of the genitals, as determined by parents and surgeons, improved following genitoplasty. Outcomes of early genitoplasty are needed to guide families when making decisions about such procedures for their young children.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dix P Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, USA.
| | | | | |
Collapse
|
5
|
Markosyan R. Patients with disorders of sex development. Ann Pediatr Endocrinol Metab 2021; 26:74-79. [PMID: 34218628 PMCID: PMC8255866 DOI: 10.6065/apem.2040240.120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/23/2020] [Indexed: 12/22/2022] Open
Abstract
Disorders of sex development (DSDs) are a genetically and clinically heterogeneous group of congenital conditions of the urogenital tract and reproductive system. Time and spatially controlled transcription factors, signal molecules, and an array of different hormones are involved in the development of sex characteristics, and variations in their pathways and actions are associated with DSD. These conditions may be caused by numerical or structural variations in sex chromosomes as well as autosomes, variations in genes involved in gonadal and/or genital development, and changes in gonadal and/or adrenal steroidogenesis. Endogenous or exogenous (maternal) and possibly endocrine disruptors may also interfere with genital development.
Collapse
Affiliation(s)
- Renata Markosyan
- Department of Endocrinology, Yerevan State Medical Universisty, Yerevan, Armenia
- "Muratsan" University Hospital, Yerevan, Armenia
| |
Collapse
|
6
|
Perez MN, Clawson AH, Baudino MN, Austin PF, Baskin LS, Chan YM, Cheng EY, Coplen D, Diamond DA, Fried AJ, Kolon T, Kropp B, Lakshmanan Y, Meyer T, Nokoff NJ, Palmer BW, Paradis A, Poppas DP, Reyes KJS, Williot P, Wolfe-Christensen C, Yerkes EB, Wisniewski AB, Mullins LL. Distress Trajectories for Parents of Children With DSD: A Growth Mixture Model. J Pediatr Psychol 2021; 46:588-598. [PMID: 33594414 DOI: 10.1093/jpepsy/jsab004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/06/2020] [Accepted: 01/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study identifies trajectories of parent depressive symptoms after having a child born with genital atypia due to a disorder/difference of sex development (DSD) or congenital adrenal hyperplasia (CAH) and across the first year postgenitoplasty (for parents who opted for surgery) or postbaseline (for parents who elected against surgery for their child). Hypotheses for four trajectory classes were guided by parent distress patterns previously identified among other medical conditions. METHODS Participants included 70 mothers and 50 fathers of 71 children diagnosed with a DSD or CAH with reported moderate to high genital atypia. Parents were recruited from 11 US DSD specialty clinics within 2 years of the child's birth and prior to genitoplasty. A growth mixture model (GMM) was conducted to identify classes of parent depressive symptoms over time. RESULTS The best fitting model was a five-class linear GMM with freely estimated intercept variance. The classes identified were termed "Resilient," "Recovery," "Chronic," "Escalating," and "Elevated Partial Recovery." Four classes have previously been identified for other pediatric illnesses; however, a fifth class was also identified. The majority of parents were classified in the "Resilient" class (67.6%). CONCLUSIONS This study provides new knowledge about the trajectories of depressive symptoms for parents of children with DSD. Future studies are needed to identify developmental, medical, or familial predictors of these trajectories.
Collapse
Affiliation(s)
- Megan N Perez
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Ashley H Clawson
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Marissa N Baudino
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | | | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Harvard Medical School and Boston Children's Hospital
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | | | - David A Diamond
- Department of Urology, Boston Children's Hospital, Harvard Medical School
| | - Allyson J Fried
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | - Thomas Kolon
- Division of Urology, Children's Hospital of Philadelphia
| | - Bradley Kropp
- Department of Pediatric Urology, Cook Children's Medical Center
| | | | - Theresa Meyer
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Natalie J Nokoff
- Department of Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus
| | - Blake W Palmer
- Department of Pediatric Urology, Cook Children's Medical Center
| | | | - Dix P Poppas
- Department of Urology, New York Presbyterian Weill Cornell Medicine
| | | | - Pierre Williot
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | | | - Elizabeth B Yerkes
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Amy B Wisniewski
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Larry L Mullins
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| |
Collapse
|
7
|
Walsh RS, Denovan A, Drinkwater K, Reddington S, Dagnall N. Predicting GP visits: A multinomial logistic regression investigating GP visits amongst a cohort of UK patients living with Myalgic encephalomyelitis. BMC FAMILY PRACTICE 2020; 21:105. [PMID: 32522264 PMCID: PMC7285543 DOI: 10.1186/s12875-020-01160-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/04/2020] [Indexed: 12/02/2022]
Abstract
Background Myalgic Encephalomyelitis (ME) is a chronic condition whose status within medicine is the subject of on-going debate. Some medical professionals regard it as a contentious illness. Others report a lack of confidence with diagnosis and management of the condition. The genesis of this paper was a complaint, made by an ME patient, about their treatment by a general practitioner. In response to the complaint, Healthwatch Trafford ran a patient experience-gathering project. Method Data was collected from 476 participants (411 women and 65 men), living with ME from across the UK. Multinomial logistic regression investigated the predictive utility of length of time with ME; geographic location (i.e. Manchester vs. rest of UK); trust in GP; whether the patient had received a formal diagnosis; time taken to diagnosis; and gender. The outcome variable was number of GP visits per year. Results All variables, with the exception of whether the patient had received a formal diagnosis, were significant predictors. Conclusions Relationships between ME patients and their GPs are discussed and argued to be key to the effective delivery of care to this patient cohort. Identifying potential barriers to doctor patient interactions in the context of ME is crucial.
Collapse
|
8
|
Baskin A, Wisniewski AB, Aston CE, Austin P, Chan YM, Cheng EY, Diamond DA, Fried A, Kolon T, Lakshmanan Y, Williot P, Meyer S, Meyer T, Kropp B, Nokoff N, Palmer B, Paradis A, Poppas D, VanderBrink B, Scott Reyes KJ, Tishelman A, Wolfe-Christensen C, Yerkes E, Mullins LL, Baskin L. Post-operative complications following feminizing genitoplasty in moderate to severe genital atypia: Results from a multicenter, observational prospective cohort study. J Pediatr Urol 2020; 16:568-575. [PMID: 32624410 PMCID: PMC7735165 DOI: 10.1016/j.jpurol.2020.05.166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/17/2020] [Accepted: 05/23/2020] [Indexed: 12/14/2022]
Abstract
Disorders/differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. While there remains controversy around the traditionally binary concept of sex, most patients with DSD are reared either male or female depending on their genetic sex, gonadal sex, genital phenotype and status of their internal genital tract. This study uses prospective data from 12 institutions across the United States that specialize in DSD care. We focused on patients raised female. Eligible patients had moderate to severe genital atypia (defined as Prader score >2), were ≤2 years of age at entry, and had no prior genitoplasty. The aim of this study is to describe early post operative complications for young patients undergoing modern approaches to feminizing genitoplasty. Of the 91 participants in the cohort, 57 (62%) were reared female. The majority had congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (n = 52), 1 had ovo-testicular syndrome, 2 had mixed gonadal dysgenesis and 2 had partial androgen insensitivity syndrome (PAIS). Of the 50 participants who received early genitoplasty, 43 (86%) had follow-up at 6-12 months post-surgery. Thirty-two participants (64%) received a clitoroplasty, 31 (62%) partial urogenital mobilization and 4 (8%) total urogenital sinus mobilization. Eighteen percent (9/50) experienced post-surgical complications with 7 (14%) being rated as Clavien-Dindo grade III. Both parents and surgeons reported improved satisfaction with genital appearance of participants following surgery compared to baseline. This information on post-operative complications associated with contemporary approaches to feminizing genitoplasty performed in young children will help guide families when making decisions about whether or not to proceed with surgery for female patients with moderate to severe genital atypia.
Collapse
Affiliation(s)
- Avi Baskin
- University of California San Francisco Medical Center, United States.
| | | | | | - Paul Austin
- Texas Children's Hospital and Baylor College of Medicine, United States.
| | | | - Earl Y Cheng
- Lurie Children's Hospital of Chicago, United States.
| | | | | | - Thomas Kolon
- Children's Hospital of Philadelphia, United States.
| | | | | | | | - Theresa Meyer
- Lurie Children's Hospital of Chicago, United States.
| | | | | | | | | | - Dix Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, United States.
| | | | | | | | | | | | | | - Laurence Baskin
- University of California San Francisco Medical Center, United States.
| |
Collapse
|
9
|
Perez MN, Delozier AM, Aston CE, Austin P, Baskin L, Chan YM, Cheng EY, Diamond DA, Fried A, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Nokoff N, Palmer B, Paradis A, Poppas D, Scott Reyes KJ, Swartz JM, Tishelman A, Wisniewski AB, Wolfe-Christensen C, Yerkes E, Mullins LL. Predictors of Psychosocial Distress in Parents of Young Children with Disorders of Sex Development. J Urol 2019; 202:1046-1051. [PMID: 31268850 DOI: 10.1097/ju.0000000000000424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated demographic, financial and support predictors of distress for parents of young children with disorders of sex development including atypical genital development, and characterized early parental experiences. This work extends our previous findings to identify those parents at risk for distress. MATERIALS AND METHODS Participants included mothers (76) and fathers (63) of a child (78) diagnosed with disorders of sex development characterized by moderate to severe genital atypia. Parents completed a demographic questionnaire, measures of anxious and depressive symptoms, quality of life, illness uncertainty and posttraumatic stress symptoms, and rated their satisfaction with the appearance of their child's genitalia. RESULTS Depressive and posttraumatic stress symptoms of caregivers were comparable to standardized norms while levels of anxious symptoms were below norms. A subset of parents reported clinically elevated symptoms. Overall 26% of parents reported anxious symptoms, 24% reported depressive symptoms and 17% reported posttraumatic stress symptoms. Levels of illness uncertainty were lower than those of parents of children with other chronic illnesses. Differences by parent sex emerged, with mothers reporting greater distress. Lower income, increased medical care and travel expenses, and having no other children were related to increased psychosocial distress. CONCLUSIONS Early psychosocial screening is recommended for parents of children with disorders of sex development. Clinicians should be aware that financial burden and lack of previous parenting experience are risk factors for distress.
Collapse
Affiliation(s)
| | | | | | - Paul Austin
- Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Laurence Baskin
- University of California San Francisco Medical Center, San Francisco, California
| | | | - Earl Y Cheng
- Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Allyson Fried
- John R. Oishei Children's Hospital, Buffalo, New York
| | | | - Thomas Kolon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Sabrina Meyer
- John R. Oishei Children's Hospital, Buffalo, New York
| | - Theresa Meyer
- Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Blake Palmer
- Cook Children's Medical Center, Ft. Worth, Texas
| | | | - Dix Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Boerner KE, Dhariwal AK. JPP Student Journal Club Commentary: When Adults Evaluate a Child's Pain: Considering Study Methodology, Gender Bias and Parental Experience. J Pediatr Psychol 2019; 44:415-417. [PMID: 30874809 DOI: 10.1093/jpepsy/jsz012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Katelynn E Boerner
- Department of Psychiatry, Faculty of Medicine, University of British Columbia.,BC Children's Hospital Research Institute
| | - Amrit K Dhariwal
- Department of Psychiatry, Faculty of Medicine, University of British Columbia.,BC Children's Hospital Research Institute
| |
Collapse
|