How paediatricians communicate with parents who access online health information

AIMS

Recent years have seen an exponential increase in the proportion of parents searching for online health information on their child's medical condition. We investigated the experiences, attitudes and approaches of paediatricians interacting with parents who search for online health information and the impact on the doctor-parent relationship.

METHODS

This qualitative study was conducted utilising semi-structured interviews with 17 paediatric physicians, surgeons, anaesthetists and trainees working in an Australian children's hospital. Data were analysed through deductive and inductive thematic analysis using line-by-line coding.

RESULTS

Three key themes were identified: paediatricians' experiences with, and attitudes towards, parents using online health information; paediatricians' communication approaches; and the perceived impact on the doctor-parent relationship. These themes demonstrated that most paediatricians acknowledged the information parents found and directed parents to reliable websites. Following discussions with Internet-informed parents, a few changed their management plans and a few reported discouraging parents from further searching online.

CONCLUSIONS

Our results indicate that paediatricians predominantly used patient-centred communication strategies to care for patients in partnership with parents. Paediatricians contextualising online health information can contribute to a quality partnership with parents and facilitate shared decision-making, potentially fostering better health outcomes for children. Our conclusions may inform clinicians' communication approaches when interacting with Internet-informed parents and stimulate research about more effective doctor-parent communication approaches. In a digital age, paediatricians may benefit from employing more time-efficient approaches to manage increasing workloads with their new role of digital stewardship of parents.

Usability, acceptability, and feasibility of a High-Density Microarray Patch (HD-MAP) applicator as a delivery method for vaccination in clinical settings

Background

High-density microarray patch (HD-MAP) vaccines may increase vaccine acceptance and use. We aimed to ascertain whether professional immunizers (PIs) and other healthcare workers (HCWs) in Australia, a High-Income Country (HIC), found the HD-MAP applicator usable and acceptable for vaccine delivery.

Methods

This feasibility study recruited PIs and HCWs to administer/receive simulated HD-MAP administration, including via self-administration. We assessed usability against essential and desirable criteria. Participants completed a survey, rating their agreement to statements about HD-MAP administration. A subset also participated in an interview or focus group. Survey data were analyzed using descriptive statistics, and interviews were transcribed and subject to thematic analysis.

Results

We recruited 61 participants: 23 PIs and 38 HCWs. Findings indicated high usability and acceptability of HD-MAP use across both groups by a healthcare professional or trained user and for self-administration with safety measures in place. Most administrations met essential criteria, but PIs, on average, applied the HD-MAP for slightly less time than the required 10-seconds, which the HCWs achieved. PIs perceived safety concerns about home administration but found layperson self-administration acceptable in an emergency, pandemic, and rural or remote settings.

Conclusions

Participants found HD-MAP administration usable and acceptable. Usability and acceptability are likely to be improved through end-user education and training.

Professional immunizers and healthcare workers found high-density microarray patch devices highly usable and acceptable to administer vaccines.

HD-MAPs may have advantages over intramuscular injections in clinical settings and in pandemics.

Vaccination with HD-MAP may improve acceptance for those with needle-related anxiety.

Three Consequent Pediatric Liver Transplant Deaths in the COVID-19 Era

The effect of COVID-19 on the transplant recipients is not well-established. Many reports underestimate the effect of COVID-19 on the immunosuppressed population. Herein, we report on 3 pediatric liver transplant recipients who were transplanted at our center between February 11 and March 10, 2020-during the COVID-19 pandemic era. The 3 patients aged between 5 and 10 months, had a rapid and aggressive respiratory deterioration that necessitated mechanical ventilation and extracorporeal life support; and eventually died. The clinical and pathological pictures likely represent COVID-19 pneumonia. Chest x-rays showed progressive infiltrates. Lung autopsies showed diffuse alveolar damage in two cases. We concluded that COVID-19 is very likely to have catastrophic effects on transplant recipients.

Eculizumab for salvage treatment of refractory antibody-mediated rejection in kidney transplant patients: case reports

Antibody-mediated rejection (AMR) in a group of preoperatively desensitized patients may follow a dreadful course and result in loss of the transplanted kidney. In several cases, conventional therapies including plasmapheresis, intravenous immunoglobulin, and anti-CD 20 therapy can resolve AMR successfully. But in some cases the load of immunoglobulins that can activate complement cascade may submerge the routine desensitization therapy and result in the formation of membrane attack complexes. Eculizumab, monoclonal antibody against C5, was reported to be an option in cases with severe AMR that are resistant to conventional therapy. Here, we present two cases of acute-onset AMR in preoperatively desensitized patients. Eculizumab was used as a salvage agent in addition to conventional therapy. Given the bad prognosis for renal transplants displaying acute injury progressing rapidly to cortical necrosis on the biopsy, the prompt use of eculizumab could have the advantage of immediate effects by stopping cellular injury. This can provide a therapeutic window to allow conventional treatment modalities to be effective and prevent early graft loss.

What has changed in pediatric kidney transplantation in Turkey? Experience of an evolving center

INTRODUCTION

Reluctance to perform kidney transplantations on children is an ongoing problem in Turkey. Moreover, urological pathologies still constitute the largest portion of the underlying etiologies in chronic renal failure patients. Herein, we retrospective analyzed the data acquired from our pediatric renal transplantation patients and reviewed the registry of dialysis and transplantation data prepared by the Turkish Society of Nephrology.

MATERIAL AND METHODS

Forty-six living donor kidney transplantations were performed in children between 2008 and 2012. Seventeen of 46 (37%) transplantations were preemptive. The mean age at operation time was 10.8 ± 5 years. The mean patient weight was 31.3 ± 15.8 kg (range, 9.4 to 66.4 kg). A detailed urologic evaluation was performed for every child with an underlying lower urinary tract disease. One enterocystoplasty and 2 ureterocystoplasties were performed for augmentation of the bladder, simultaneously.

RESULTS

One-year death-censored graft survival and patient survival rates were 100% and 97.8%, respectively. The mean serum creatinine level was 0.86 ± 0.32 mg/dL (range, 0.3 to 1.8 mg/dL). None of the patients had vascular complications or acute tubular necrosis. One patient suffered graft-versus-host disease during the second month after renal transplantation and died with a functioning graft. In one patient with massive proteinuria detected after transplantation, recurrence of primary disease (focal segmental glomerulosclerosis) was considered and the patient was treated successfully with plasmapheresis. One child had an acute cellular rejection and was administered pulse steroid treatment.

CONCLUSION

Although challenging, all patients in all pediatric age groups can successfully be operated and managed. With careful surgical technique, close postoperative follow-up, and efforts by the experienced and respectful surgical teams in this country, we could change the negative trends toward perform kidney transplantation in the Turkish pediatric population.

Investigation of the Moldability Parameters of PEG Based Steatite Feedstocks by Powder Injection Molding

In powder injection molding (PIM) barrel temperature, injection pressure and injection rate are important parameters for the molding of powder-binder mixtures. Improperly selected parameters lead to undesired problems such as separation of the powder-binder mixture and formation of collapses and cracks on the structure of the molded parts. In this study, steatite feedstocks based on PEG (polyethylene glycol) binders were injection molded into rectangular shape, ordered thickness with steps and zig-zag shaped mold cavities. The effects of the temperature and pressure of injection, rate of filling, temperature of the mold wall and geometry of the mold cavities were investigated. The optimum molding parameters of the feedstocks for the zig-zag shaped mold were determined to be an injection pressure of 80 to 140 MPa, a barrel temperature of 190 to 230°C, an injection rate of 5–25 · 10−6 m3 s−1 and a mold wall temperature of 32°C.