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Knatten CK, Dahlseng MO, Perminow G, Skari H, Austrheim AI, Nyenget T, Aabakken L, Schistad O, Stensrud KJ, Bjørnland K. Push-PEG or Pull-PEG: Does the Technique Matter? A Prospective Study Comparing Outcomes After Gastrostomy Placement. J Pediatr Surg 2024:S0022-3468(24)00199-4. [PMID: 38604831 DOI: 10.1016/j.jpedsurg.2024.03.045] [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: 12/27/2023] [Revised: 03/04/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Push-PEG (percutaneous endoscopic gastrostomy) with T-fastener fixation (PEG-T) allows one-step insertion of a balloon tube or button, and avoids contamination of the stoma by oral bacteria. However, PEG-T is a technically more demanding procedure with a significant learning curve. The aim of the present study was to compare outcomes after PEG-T and pull-PEG in a setting where both procedures were well established. MATERIALS AND METHODS The study is a prospective cohort study including all patients between 0 and 18 year undergoing PEG-T and pull-PEG between 2017 and 2020 at a combined local and tertiary referral center. Complications and parent reported outcomes were recorded during hospital stay, after 14 days and 3 months postoperatively. RESULTS 82 (93%) of eligible PEG-T and 37 (86%) pull-PEG patients were included. The groups were not significantly different with regard to age or weight. Malignant disorders and heart conditions were more frequent in the pull-PEG group, whilst neurodevelopmental disorders were more frequent in the PEG-T group (p < 0.001). 54% in both groups had a complication within 2 weeks. Late complications (between 2 weeks and 3 months postoperatively) occurred in 63% PEG-T vs 62% pull-PEG patients (p = 0.896). More parents in the pull-PEG group (49%) reported that the gastrostomy tube restricted their child's activity, compared to PEG-T (24%) (p = 0.01). At 3 months follow-up, more pull-PEG patients (43%) reported discomfort from the gastrostomy compared to PEG-T (21%) (p = 0.03). CONCLUSION Overall complication rates were approximately similar, but pull-PEG was associated with more discomfort and restriction of activity. LEVELS OF EVIDENCE Treatment study level II.
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Affiliation(s)
| | | | - Gøri Perminow
- Department of Pediatrics, Oslo University Hospital, Norway
| | - Hans Skari
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway
| | | | - Tove Nyenget
- Department of Pediatrics, Oslo University Hospital, Norway
| | - Lars Aabakken
- Department of Gastroenterology, Oslo University Hospital, Norway; University of Oslo, Norway
| | - Ole Schistad
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway
| | - Kjetil Juul Stensrud
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway
| | - Kristin Bjørnland
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway; University of Oslo, Norway
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2
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Haspels HN, de Lange AA, Alsem MW, Sandbergen B, Dulfer K, de Hoog M, Joosten KFM, van Karnebeek CD, van Woensel JBM, Maaskant JM. Hospital-to-home transitions for children with medical complexity: part 2-a core outcome set. Eur J Pediatr 2023; 182:3833-3843. [PMID: 37338690 PMCID: PMC10570151 DOI: 10.1007/s00431-023-05049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/19/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023]
Abstract
Appropriate outcome measures as part of high-quality intervention trials are critical to advancing hospital-to-home transitions for Children with Medical Complexity (CMC). Our aim was to conduct a Delphi study and focus groups to identify a Core Outcome Set (COS) that healthcare professionals and parents consider essential outcomes for future intervention research. The development process consisted of two phases: (1) a three-round Delphi study in which different professionals rated outcomes, previously described in a systematic review, for inclusion in the COS and (2) focus groups with parents of CMC to validate the results of the Delphi study. Forty-five professionals participated in the Delphi study. The response rates were 55%, 57%, and 58% in the three rounds, respectively. In addition to the 24 outcomes from the literature, the participants suggested 12 additional outcomes. The Delphi rounds resulted in the following core outcomes: (1) disease management, (2) child's quality of life, and (3) impact on the life of families. Two focus groups with seven parents highlighted another core outcome: (4) self-efficacy of parents. Conclusion: An evidence-informed COS has been developed based on consensus among healthcare professionals and parents. These core outcomes could facilitate standard reporting in future CMC hospital to home transition research. This study facilitated the next step of COS development: selecting the appropriate measurement instruments for every outcome. What is Known: • Hospital-to-home transition for Children with Medical Complexity is a challenging process. • The use of core outcome sets could improve the quality and consistency of research reporting, ultimately leading to better outcomes for children and families. What is New: • The Core Outcome Set for transitional care for Children with Medical Complexity includes four outcomes: disease management, children's quality of life, impact on the life of families, and self-efficacy of parents.
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Affiliation(s)
- Heleen N Haspels
- Department of Pediatric Intensive Care Unit, Amsterdam Reproduction and Development, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Pediatric and Neonatal Intensive Care, Division of Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, 3015 CN, The Netherlands
| | - Annemieke A de Lange
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Mattijs W Alsem
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Karolijn Dulfer
- Department of Pediatric and Neonatal Intensive Care, Division of Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, 3015 CN, The Netherlands
| | - Matthijs de Hoog
- Department of Pediatric and Neonatal Intensive Care, Division of Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, 3015 CN, The Netherlands
| | - Koen F M Joosten
- Department of Pediatric and Neonatal Intensive Care, Division of Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, 3015 CN, The Netherlands
| | - Clara D van Karnebeek
- Department of Pediatrics and Human Genetics, Emma Center for Personalized Medicine, Amsterdam Reproduction and Development, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Job B M van Woensel
- Department of Pediatric Intensive Care Unit, Amsterdam Reproduction and Development, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jolanda M Maaskant
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
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3
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McCormack S, Patel K, Smith C. Blended diet for enteral tube feeding in young people: A systematic review of the benefits and complications. J Hum Nutr Diet 2023; 36:1390-1405. [PMID: 36692240 DOI: 10.1111/jhn.13143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Interest and use of blended diets (BD) for young people who are tube fed has significantly increased in the last decade, driven primarily by the desires of motivated caregivers. This review identified, appraised and synthesised the available evidence on the benefits and complications of BD versus commercial feeds. METHODS A systematic review following PRISMA guidance and registered with PROSPERO was conducted across PubMed, Embase, CINAHL, Scopus and Cochrane up to August 2022. INCLUSION CRITERIA English language studies including (1) children, (2) original research (interventional and observational) and (3) examination of BD outcomes. Exclusion criteria were (1) unoriginal research or case reports, (2) focus on feeding management, preparations or attitudes and (3) comparing commercial blends only. Data were synthesised using an established narrative synthesis approach using the Mixed Methods Appraisal Tool. RESULTS Eight hundred and six database results were identified and 61 were sought for retrieval. A full-text article review revealed seven eligible studies, involving 267 participants (age range 9 months to 26 years). Studies reported differences in gastrointestinal symptoms (n = 222), medication use (n = 119), growth (n = 189) and complications or adverse events (n = 91). The results indicate positive outcomes, particularly in gastrointestinal symptom control, with few reports of mild adverse events in the included studies. CONCLUSIONS There is a paucity of data in this area and much heterogeneity in the included studies, but the available literature points towards positive outcomes. This is an important and highly relevant topic, and more primary research, ideally using standardised reporting, is required to answer the key questions.
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Affiliation(s)
- Siobhan McCormack
- Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK
- Department of Child Development and Neurodisability, Children's Health Ireland at Tallaght, Dublin, Ireland
| | - Kamal Patel
- Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK
- Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK
| | - Chris Smith
- Department of Paediatric Dietetics, Royal Alexandra Children's Hospital, Brighton, UK
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4
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Ronen GM. Capturing Meaningful Outcomes in -Pediatric Neurology: Further Reflections on Principles, Challenges, and Opportunities. Pediatr Neurol 2022; 135:38-43. [PMID: 35985086 DOI: 10.1016/j.pediatrneurol.2022.07.012] [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: 03/04/2022] [Revised: 06/23/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
Patient and public involvement in health care is considered indispensable in the way we conduct daily pediatric neurology practice, and in the development and utilization of health outcome measurements. This essay examines what meaningful quality evaluations and measurements are, describes the development of approaches to measuring health and outcomes, explores the potential applications of patient-reported outcome measures in pediatric neurology, and identifies opportunities and challenges in using patient-reported outcome measurements in our daily clinical practice. Recent developments have transformed our attitude on how to help children with neurological and developmental conditions and their families: specifically, (1) the recognition of the fundamental rights of children with disabilities; (2) the application of the framework of the International Classification of Functioning, Disability and Health by the World Health Organization that views health from the perspective of both biopsychosocial strengths and functional abilities; (3) the application of qualitative research methodologies to children with neurological conditions and their caregivers to elucidate what they consider essential for their own good health and well-being; and (4) the development of core outcome measurements sets for children and adults with various neurological and developmental conditions. In summary, supporting patients in their role as full partners in clinical care and research enables them to contribute their experiential knowledge and helps ensure that results are relevant and address patient needs, preferences, and priorities. Recognizing the importance of involving young people in their health management decisions has become central in contemporary medicine and needs to be part of the curriculum of all health care professionals.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University, Faculty of Health Sciences, CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada.
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5
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Harbottle V, Arnott B, Gale C, Rowen E, Kolehmainen N. Identifying common health indicators from paediatric core outcome sets: a systematic review with narrative synthesis using the WHO International Classification of Functioning, Health and Disability. BMJ Paediatr Open 2022; 6:e001537. [PMID: 36645779 PMCID: PMC9621176 DOI: 10.1136/bmjpo-2022-001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/19/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Indicators of child health have the potential to inform societal conversations, decision-making and prioritisation. Paediatric core outcome sets are an increasingly common way of identifying a minimum set of outcomes for trials within clinical groups. Exploring commonality across existing sets may give insight into universally important and inclusive child health indicators. METHODS A search of the Core Outcome Measures in Effectiveness Trial register from 2008 to 2022 was carried out. Eligible articles were those reporting on core outcome sets focused on children and young people aged 0-18 years old. The International Classification of Functioning, Disability and Health (ICF) was used as a framework to categorise extracted outcomes. Information about the involvement of children, young people and their families in the development of sets was also extracted. RESULTS 206 articles were identified, of which 36 were included. 441 unique outcomes were extracted, mapping to 22 outcome clusters present across multiple sets. Medical diagnostic outcomes were the biggest cluster, followed by pain, communication and social interaction, mobility, self-care and school. Children and young people's views were under-represented across core outcome sets, with only 36% of reviewed studies including them at any stage of development. CONCLUSIONS Existing paediatric core outcome sets show overlap in key outcomes, suggesting the potential for generic child health measurement frameworks. It is unclear whether existing sets best reflect health dimensions important to children and young people, and there is a need for better child and young person involvement in health indicator development to address this.
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Affiliation(s)
- Victoria Harbottle
- Rehabilitation Department, Great North Children's Hospital, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Bronia Arnott
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Gale
- Academic Neonatal Medicine, Imperial College London, London, UK
| | - Elizabeth Rowen
- Rehabilitation Department, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Niina Kolehmainen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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6
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Macarthur C, Cohen E, Adams S, Buchanan F, Saunders NR, Friedman JN. From Philanthropy to Clinical Care through Research: Impact of the Norman Saunders Complex Care Initiative. CHILDREN 2022; 9:children9030395. [PMID: 35327767 PMCID: PMC8946877 DOI: 10.3390/children9030395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
Norman Saunders was a respected academic community paediatrician who was passionate about the care of children with medical complexity. Following his untimely death at age 60, patients, friends, and colleagues raised funds to create the Norman Saunders Complex Care Initiative (NSCCI). Dr. Saunders’s vision was a comprehensive, coordinated, and integrated clinical program for children with medical complexity that was informed by research evidence. The objective of this review was to evaluate the impact of targeted philanthropic funding on research, clinical care, and policy. Since 2006, NSCCI funds have been used to support interdisciplinary and innovative research. Funded projects have reflected a breadth of research questions (clinical care, training, health system delivery, social determinants), disciplines, and methods, and the research results have informed and helped build an internationally renowned clinical program in complex care. Philanthropic funding was the foundation for the NSCCI, which over the last 15 years has built research and clinical capacity, catalysed clinical and research networks, helped train paediatric residents, influenced policy, and improved the health and well-being of children with medical complexity and their families across Canada, and beyond.
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Affiliation(s)
- Colin Macarthur
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON M5G 0A4, Canada; (E.C.); (S.A.); (F.B.); (N.R.S.); (J.N.F.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada
- Correspondence: ; Tel.: +1-416-813-7654 (ext. 309313)
| | - Eyal Cohen
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON M5G 0A4, Canada; (E.C.); (S.A.); (F.B.); (N.R.S.); (J.N.F.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada
- Complex Care Program, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Sherri Adams
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON M5G 0A4, Canada; (E.C.); (S.A.); (F.B.); (N.R.S.); (J.N.F.)
- Complex Care Program, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Francine Buchanan
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON M5G 0A4, Canada; (E.C.); (S.A.); (F.B.); (N.R.S.); (J.N.F.)
| | - Natasha R. Saunders
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON M5G 0A4, Canada; (E.C.); (S.A.); (F.B.); (N.R.S.); (J.N.F.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Jeremy N. Friedman
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON M5G 0A4, Canada; (E.C.); (S.A.); (F.B.); (N.R.S.); (J.N.F.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada
- Complex Care Program, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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7
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Ronen GM, Rosenbaum PL, Streiner DL. Patient perspectives in pediatric neurology: a critical shift in the paradigm of outcome measurement. Dev Med Child Neurol 2022; 64:149-155. [PMID: 34091886 DOI: 10.1111/dmcn.14954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 01/19/2023]
Abstract
This review explores children's self-reported outcome measurements in pediatric neurology. We examine the following questions: (1) What is meant by patient-reported health, functioning, and quality of life outcomes? (2) How can patients express whether the interventions they receive do more good than harm? (3) Why and how should pediatric neurology patients help determine the outcomes of interest? (4) What tools and recommendations are available to evaluate the outcomes of interest? Applying patients' perspectives across the processes of evaluation of medical interventions has become an important expectation. These developments, consistent with current healthcare goals, coincide with the evolution of pediatric neurology into a sophisticated diagnostic-interventional field that aims to prolong survival, decrease impairments and symptoms, and improve patients' well-being - the recognized essential endpoints of interest in all medicine.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, CanChild Centre for Childhood Disability Research, Institute for Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Peter L Rosenbaum
- Department of Pediatrics, CanChild Centre for Childhood Disability Research, Institute for Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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8
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Maddison J, Taylor J, O'Neill M, Cade J, Hewitt C, Horridge K, McCarter A, Fraser LK, Beresford B. Outcomes for gastrostomy-fed children and their parents: qualitative findings from the 'Your Tube' study. Dev Med Child Neurol 2021; 63:1099-1106. [PMID: 33792913 DOI: 10.1111/dmcn.14868] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 12/20/2022]
Abstract
AIM To identify child and parent outcomes relevant to having a gastrostomy, and to specify outcomes believed to be particularly salient to type of diet (formula vs blended food). METHOD Twenty parents, two children (both 12y), and 41 professionals (dietitians [n=10]; nurses [n=12]; paediatricians [n=12]; speech and language therapists [n=7)]) were recruited. Parents and children were interviewed; professionals participated in focus groups. Children (2-18y) represented included those on formula (n=11), blended-food (n=7), and mixed (n=2) diets. All had been tube-fed for at least 6 months. Neurological, genetic, and metabolic conditions were represented. RESULTS Participants identified a range of children's outcomes relevant to a gastrostomy, including physical health, gastrointestinal symptoms, sleep, and time spent feeding. The children described experiences of exclusion caused by being tube-fed. Time, sleep, and emotional health were regarded as most salient to understanding parents' gastrostomy outcomes. Participants believed type of diet would most likely effect gastrointestinal symptoms, time spent feeding, sleep, and physical health. INTERPRETATION Findings indicate a number of refinements to, and allow further specification of, the current 'initial' core outcome set for tube-fed children. Findings also have implications for choice of outcomes measures. Further qualitative research with children and young people is needed. What this paper adds Sleep is a key outcome for children and parents. Gastrointestinal symptoms and physical health were regarded as outcomes most likely to be affected by type of diet. Well-being and participation were identified as key distal outcomes. Gastrostomies are complex interventions. Further specification of the core outcome set is possible.
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Affiliation(s)
- Jane Maddison
- Social Policy Research Unit, University of York, York, UK
| | - Johanna Taylor
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Mark O'Neill
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Janet Cade
- Nutritional Epidemiology Group, University of Leeds, Leeds, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Karen Horridge
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | | | - Lorna K Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
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Pugliese M, Tingley K, Chow A, Pallone N, Smith M, Chakraborty P, Geraghty MT, Irwin JK, Mitchell JJ, Stockler S, Nicholls SG, Offringa M, Rahman A, Tessier LA, Butcher NJ, Iverson R, Lamoureux M, Clifford TJ, Hutton B, Paik K, Tao J, Skidmore B, Coyle D, Duddy K, Dyack S, Greenberg CR, Jain Ghai S, Karp N, Korngut L, Kronick J, MacKenzie A, MacKenzie J, Maranda B, Potter M, Prasad C, Schulze A, Sparkes R, Taljaard M, Trakadis Y, Walia J, Potter BK. Core Outcome Sets for Medium-Chain Acyl-CoA Dehydrogenase Deficiency and Phenylketonuria. Pediatrics 2021; 148:peds.2020-037747. [PMID: 34266901 DOI: 10.1542/peds.2020-037747] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Evidence to guide treatment of pediatric medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency and phenylketonuria (PKU) is fragmented because of large variability in outcome selection and measurement. Our goal was to develop core outcome sets (COSs) for these diseases to facilitate meaningful future evidence generation and enhance the capacity to compare and synthesize findings across studies. METHODS Parents and/or caregivers, health professionals, and health policy advisors completed a Delphi survey and participated in a consensus workshop to select core outcomes from candidate lists of outcomes for MCAD deficiency and PKU. Delphi participants rated the importance of outcomes on a nine-point scale (1-3: not important, 4-6: important but not critical, 7-9: critical). Candidate outcomes were progressively narrowed down over 3 survey rounds. At the workshop, participants evaluated the remaining candidate outcomes using an adapted nominal technique, open discussion, and voting. After the workshop, we finalized the COSs and recommended measurement instruments for each outcome. RESULTS There were 85, 61, and 53 participants across 3 Delphi rounds, respectively. The candidate core outcome lists were narrowed down to 20 outcomes per disease to be discussed at the consensus workshop. Voting by 18 workshop participants led to COSs composed of 8 and 9 outcomes for MCAD deficiency and PKU, respectively, with measurement recommendations. CONCLUSIONS These are the first known pediatric COSs for MCAD deficiency and PKU. Adoption in future studies will help to ensure best use of limited research resources to ultimately improve care for children with these rare diseases.
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Affiliation(s)
- Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Andrea Chow
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Nicole Pallone
- Patient partner, Canadian Organization for Rare Disorders, Toronto, Canada
| | | | - Pranesh Chakraborty
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.,Divisions of Medical Genetics and Pediatric Endocrinology, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Michael T Geraghty
- Divisions of Medical Genetics and Pediatric Endocrinology, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Julie K Irwin
- Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada
| | - John J Mitchell
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sylvia Stockler
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Stuart G Nicholls
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Martin Offringa
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Alvi Rahman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Laure A Tessier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Nancy J Butcher
- Department of Pediatrics, Dalhousie University, Halifax, Canada.,Patient partner, Canadian Phenylketonuria & Allied Disorders Inc, Toronto, Canada
| | - Ryan Iverson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Monica Lamoureux
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Tammy J Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Brian Hutton
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Karen Paik
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jessica Tao
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Becky Skidmore
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kathleen Duddy
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Sarah Dyack
- Department of Medical Genetics, University of Alberta, Edmonton, Canada
| | | | - Shailly Jain Ghai
- Departments of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Natalya Karp
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Canada
| | - Lawrence Korngut
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Jonathan Kronick
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Alex MacKenzie
- Division of Metabolics, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Bruno Maranda
- Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Murray Potter
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Canada
| | - Chitra Prasad
- Departments of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Andreas Schulze
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Rebecca Sparkes
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Yannis Trakadis
- Medical Genetics, and Pediatrics, University of Calgary, Calgary, Canada
| | - Jagdeep Walia
- Department of Human Genetics, McGill University, Montreal, Canada
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10
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Hopwood N, Elliot C, Moraby K, Dadich A. Parenting children who are enterally fed: How families go from surviving to thriving. Child Care Health Dev 2020; 46:741-748. [PMID: 32901970 DOI: 10.1111/cch.12808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Complex feeding difficulties requiring enteral (tube) feeding affect everyone around the child. Parents experience additional stress and are at risk of social isolation. This study investigated the strategies families develop and use to adjust and adapt to enteral feeding so they were not just surviving but thriving as a family. METHODS Twenty parents whose children had been or continued to be enterally fed were interviewed, four of them twice as their experience of enteral feeding progressed. Learning theory was used to conceptualize findings in terms of changing use of tools that mediated parents' response to feeding-related challenges. RESULTS Parents encountered dilemmas relating to enteral feeding: maintaining participation in everyday activities, managing responses to the use of tubes for feeding, and doing what feels right for their child. They used four kinds of mediating tools to overcome these: memory aids and readiness tools, metaphors and narratives, repurposed everyday objects and personalized routines and materialities. CONCLUSIONS This novel account of tool used to resolve dilemmas provides an empirically and theoretically grounded basis for supporting parents to thrive despite the challenges of enteral feeding. Specifically, it can guide information given to help parents anticipate and cope with dilemmas arising from enteral feeding.
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Affiliation(s)
- Nick Hopwood
- School of International Studies and Education, University of Technology Sydney, Broadway, New South Wales, Australia.,Department of Curriculum Studies, Stellenbosch University, Matieland, South Africa
| | - Chris Elliot
- Department of Pediatrics, St George Hospital, Kogarah, New South Wales, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Community Child Health, Sydney Children's Hospitals Randwick, Sydney, New South Wales, Australia
| | - Khadeejah Moraby
- Central Early Childhood and Families Service, Allied Health, Women's and Children's Health Network, North Adelaide, South Australia, Australia.,Speech Pathology Department, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Penrith, New South Wales, Australia
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11
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Muhly WT, Taylor E, Razavi C, Walker SM, Yang L, de Graaff JC, Vutskits L, Davidson A, Zuo Y, Pérez-Pradilla C, Echeverry P, Torborg AM, Xu T, Rawlinson E, Subramanyam R, Whyte S, Seal R, M Meyer H, Yaddanapudi S, Goobie SM, Cravero JP, Keaney A, Graham MR, Ramo T, Stricker PA. A systematic review of outcomes reported inpediatric perioperative research: A report from the Pediatric Perioperative Outcomes Group. Paediatr Anaesth 2020; 30:1166-1182. [PMID: 32734593 DOI: 10.1111/pan.13981] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/20/2020] [Indexed: 02/05/2023]
Abstract
The Pediatric Perioperative Outcomes Group (PPOG) is an international collaborative of clinical investigators and clinicians within the subspecialty of pediatric anesthesiology and perioperative care which aims to use COMET (Core Outcomes Measures in Effectiveness Trials) methodology to develop core outcome setsfor infants, children and young people that are tailored to the priorities of the pediatric surgical population.Focusing on four age-dependent patient subpopulations determined a priori for core outcome set development: i) neonates and former preterm infants (up to 60 weeks postmenstrual age); ii) infants (>60 weeks postmenstrual age - <1 year); iii) toddlers and school age children (>1-<13 years); and iv) adolescents (>13-<18 years), we conducted a systematic review of outcomes reported in perioperative studies that include participants within age-dependent pediatric subpopulations. Our review of pediatric perioperative controlled trials published from 2008 to 2018 identified 724 articles reporting 3192 outcome measures. The proportion of published trials and the most frequently reported outcomes varied across pre-determined age groups. Outcomes related to patient comfort, particularly pain and analgesic requirement, were the most frequent domain for infants, children and adolescents. Clinical indicators, particularly cardiorespiratory or medication-related adverse events, were the most common outcomes for neonates and infants < 60 weeks and were the second most frequent domain at all other ages. Neonates and infants <60 weeks of age were significantly under-represented in perioperative trials. Patient-centered outcomes, heath care utilization, and bleeding/transfusion related outcomes were less often reported. In most studies, outcomes were measured in the immediate perioperative period, with the duration often restricted to the post-anesthesia care unit or the first 24 postoperative hours. The outcomes identified with this systematic review will be combined with patient centered outcomes identified through a subsequent stakeholder engagement study to arrive at a core outcome set for each age-specific group.
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Affiliation(s)
- Wallis T Muhly
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Elsa Taylor
- Auckland District Health Board, Pediatric Anesthesia, Starship Children's Hospital, Auckland, New Zealand
| | - Cyrus Razavi
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
- Research Department of Targeted Intervention, Centre for Perioperative Medicine, University College London, London, UK
| | - Suellen M Walker
- Clinical Neurosciences (Pain Research), UCL GOS Institute of Child Health, London, UK
- Department of Anaesthesia and Pain Medicine, Great Ormond St Hospital NHS Foundation Trust, London, UK
| | - Lei Yang
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Jurgen C de Graaff
- Department of Anesthesiology, Erasmus MC - Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laszlo Vutskits
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Andrew Davidson
- Department of Anaesthesia, Royal Children's Hospital, Parkville, Vic., Australia; Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia; Anaesthesia Research Group, Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | | | - Piedad Echeverry
- Department of Pediatric Anesthesiology, Instituto Roosevelt, Bogotá, Colombia
| | - Alexandra M Torborg
- Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ting Xu
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Ellen Rawlinson
- Department of Anaesthesia and Pain Medicine, Great Ormond St Hospital NHS Foundation Trust, London, UK
| | - Rajeev Subramanyam
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Simon Whyte
- Department of Anesthesia, British Columbia Children's Hospital, University of Britisch Columbia, Vancouver, Canada
| | - Robert Seal
- Department of Anesthesia and Pain Medicine, University of Alberta, Edmonton, Canada
| | - Heidi M Meyer
- Department of Anaesthesia and Perioperative Medicine, Division of PaediatricAnaesthesia, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sandhya Yaddanapudi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Susan M Goobie
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph P Cravero
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aideen Keaney
- Department of Anaesthesia& Critical Care Medicine, Royal Belfast Hospital for Sick Children, Belfast, Ireland
| | - M Ruth Graham
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Tania Ramo
- Department of Nursing, Royal Children's Hospital, Parkville, Vic, Australia
| | - Paul A Stricker
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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12
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Cass H. Gastrostomy in children with neurological impairments: many a slip twixt tube and lip. Dev Med Child Neurol 2020; 62:156. [PMID: 31418817 DOI: 10.1111/dmcn.14335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hilary Cass
- Evelina London Children's Hospital, London, UK
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