Tracheostomy Decision Making and Counseling: Comparing Providers' and Caregivers' Perspectives and Perceptions.

The decision to place a tracheostomy in children is complex and involves factors beyond the medical procedure, including quality of life, values, and goals. Providers play an important role in counseling caregivers and guiding them through the decision-making process. There are no established guidelines for tracheostomy counseling, leading to variations in practice.

Ethical Considerations in Critically Ill Neonatal and Pediatric Patients.

The care of critically ill neonates and pediatric patients can be particularly emotionally and ethically challenging. Emerging evidence suggests that we can improve the patient, family, and care team experience in the critical care setting through a better understanding and application of ethical frameworks and communication strategies. We conducted a multidisciplinary panel session at the American Academy of Pediatrics National Conference and Exhibition in the fall of 2022 wherein we explored a myriad of ethical and communication considerations in this unique patient population, with congenital diaphragmatic hernia (CDH) as the congenital anomaly/disease framework.

Teaching the Skill of Shared Decision Making Utilizing a Novel Online Module: A Pilot Randomized Controlled Study.

Objectives: In this pilot study, we developed and tested an online educational module for the purpose of teaching optimal shared decision making (SDM) behaviors for physicians in training. We hypothesized that those who received this intervention would show significant improvement in SDM behaviors afterward as compared with those who had not received the intervention.

Methods: Pediatric subspecialty fellows (pediatric critical care medicine, neonatology, hematology and oncology, and pulmonology) at the Monroe Carell Jr Children's Hospital at Vanderbilt were eligible to participate, if approved by their respective program directors.

Ethical Considerations in Ever-Expanding Utilization of ECLS: A Research Agenda.

Technological advancements and rapid expansion in the clinical use of extracorporeal life support (ECLS) across all age ranges in the last decade, including during the COVID-19 pandemic, has led to important ethical considerations. As a costly and resource intensive therapy, ECLS is used emergently under high stakes circumstances where there is often prognostic uncertainty and risk for serious complications. To develop a research agenda to further characterize and address these ethical dilemmas, a working group of specialists in ECLS, critical care, cardiothoracic surgery, palliative care, and bioethics convened at a single pediatric academic institution over the course of 18 months.

Fifteen-minute consultation: How to undertake an effective video consultation for children, young people and their families.

The COVID-19 pandemic has changed how we work in paediatrics with increasing use of virtual consultations. When optimised, a great deal can be achieved through video consultation compared with telephone, but accessibility and clinical risk need to be carefully considered and managed. This article aims to provide a structured approach with top tips for planning and delivering video consultations effectively in paediatrics.

Framing the future: Family preparedness for care transitions of critically ill children.

Introduction: Improving family centered care in the PICU requires understanding the milestones that families need assistance preparing for as well as factors that facilitate or obstruct preparedness. We present a model of family preparedness for transitions in the PICU based on semistructured interviews with clinicians and families that is designed to improve family centered care through the reduction of failed or traumatic transitions.

Method: We conducted semistructured interviews with 20 clinicians and 25 families in an academic PICU.

When Only Family Is Available to Interpret.

When caring for patients and families who do not speak English, medical interpreters are necessary. Sometimes, our patients' families speak languages or dialects for which no in-person or video or phone interpreter can be found. If a family member is bilingual, the members of the medical team must make a difficult choice.

Childhood disintegrative disorder and autism spectrum disorder: a systematic review.

Aim: In an attempt to clarify the debate surrounding the diagnostic validity of childhood disintegrative disorder (CDD), we systematically reviewed its characteristics and compared it with autism spectrum disorder (ASD).

Method: Four databases were searched (PubMed, PsycINFO, Embase, and Web of Science). Included articles had participants with CDD, as defined by symptoms present in the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and the International Classification of Diseases, 10th Revision.

Providing Palliative Care in the Medical ICU: A Qualitative Study of MICU Physicians' Beliefs and Practices.

Context: With the current and projected shortage of palliative care (PC) specialists, an integrative model of PC will be needed to meet the needs of patients in intensive care units (ICUs). Prior studies of PC interventions suggest that success depends upon meeting the needs of individual institutions or ICUs.

Objective: The objective of this study was to qualitatively explore the beliefs and practices of one institution's medical ICU (MICU) physicians in regard to providing an integrative model of PC.

Fifteen-minute consultation on problems in the healthy child: sleep.

Sleep-related issues are common reasons children present to health professionals. Many factors can adversely affect sleep quality, and there are many associations of inadequate sleep, including behavioural problems, obesity and accidental injury. We review the current evidence, and suggest practical management strategies to promote better sleep, and hopefully, better functioning for child and family alike.

Examining palliative care team involvement in automatic consultations for children on extracorporeal life support in the pediatric intensive care unit.

Background: Extracorporeal life support (ECLS) is an advanced form of life-sustaining therapy that creates stressful dilemmas for families. In May 2009, Seattle Children's Hospital (SCH) implemented a policy to involve the Pediatric Advanced Care Team (PACT) in all ECLS cases through automatic referral.

Objective: Our aim was to describe PACT involvement in the context of automatic consultations for ECLS patients and their family members.

Osmotic demyelination syndrome associated with hypophosphataemia: 2 cases and a review of literature.

Aim: Central and extrapontine myelinolysis are collectively known as osmotic demyelination syndrome. This encephalopathic illness has been well documented in the adult literature, occurring most commonly in the context of chronic alcoholism, correction of hyponatraemia and liver transplantation. Aetiology and outcome in the paediatric population are less well understood.