Motivational interviewing from the paediatricians' perspective: assessments after a 2-day training for physicians caring for adolescents with chronic medical conditions (CMCs).

Background: Counselling adolescents with chronic medical conditions (CMCs) can be challenging regarding suitable interviewing skills and clinicians' attitudes toward the patient. Successful communication can be a key element of treatment. Motivational Interviewing (MI) is broadly applicable in managing behavioural problems and diseases by increasing patient motivation for lifestyle changes.

The Impact of COVID-19 Pandemic on Mental Health of Adolescents With Chronic Medical Conditions: Findings From a German Pediatric Outpatient Clinic.

Purpose: The impact of the COVID-19 pandemic on the mental health of adolescents is of great concern, especially in the vulnerable group of adolescents with chronic medical conditions. The aim of this study was to examine this impact on the mental health of adolescents with chronic medical conditions treated in a German pediatric outpatient clinic.

Methods: Changes in the mental health status of adolescents with chronic medical conditions treated in a German pediatric outpatient clinic during the COVID-19 pandemic were explored via validated screening tools for anxiety and depression.

Efficacy of Motivational Interviewing to Improve Utilization of Mental Health Services Among Youths With Chronic Medical Conditions: A Cluster Randomized Clinical Trial.

Importance: Despite the high prevalence of anxiety and depression in youths with chronic medical conditions (CMCs), physicians encounter substantial barriers in motivating these patients to access mental health care services.

Objective: To determine the efficacy of motivational interviewing (MI) training for pediatricians in increasing youths' use of mental health care.

Design, Setting, And Participants: The COACH-MI (Chronic Conditions in Adolescents: Implementation and Evaluation of Patient-Centered Collaborative Healthcare-Motivational Interviewing) study was a single-center cluster randomized clinical trial at the University Children's Hospital specialized outpatient clinics in Düsseldorf, Germany.

A medical device-grade T1 and ECV phantom for global T1 mapping quality assurance-the T Mapping and ECV Standardization in cardiovascular magnetic resonance (T1MES) program.

Background: T mapping and extracellular volume (ECV) have the potential to guide patient care and serve as surrogate end-points in clinical trials, but measurements differ between cardiovascular magnetic resonance (CMR) scanners and pulse sequences. To help deliver T mapping to global clinical care, we developed a phantom-based quality assurance (QA) system for verification of measurement stability over time at individual sites, with further aims of generalization of results across sites, vendor systems, software versions and imaging sequences. We thus created T1MES: The T1 Mapping and ECV Standardization Program.

Outcome of oral food challenges in children in relation to symptom-eliciting allergen dose and allergen-specific IgE.

Background: Oral food challenge (FC) protocols are discussed with reference to starting doses, dose increments, safety, and predictability of results. The aim of this study was to evaluate the relation of eliciting allergen doses, specific IgE levels and predictive factors to the outcome of FCs in children.

Methods: In 869 children (median age 1.

Diagnosis of food allergy in children: toward a standardization of food challenge.

Adverse reactions to food represent a common complaint in childhood; however, only a small proportion of children have proven clinically relevant food allergy. The foods most commonly involved in food allergy are cow's milk, hen's eggs, peanuts, tree nuts, seeds, soy, wheat, fish, and crustaceans. The diagnostic workup of suspected food allergy includes the patient's history, skin prick testing, the measurement of food-specific immunoglobulin E antibodies, and, more recently, the atopy patch test.

Thoracoscopic thymectomy in the treatment concept for myasthenia gravis.

Myasthenia gravis (MG) is a chronic autoimmune disease that usually responds positively to treatment with thymectomy. Standard surgical procedures have been shown to result in a beneficial outcome. This Chapter includes discussions regarding what are controversial, and opinions as to what constitutes the optimal access to be used for thymectomy.

The predictive value of the skin prick test weal size for the outcome of oral food challenges.

Background: The skin prick test (SPT) is regarded as an important diagnostic measure in the diagnostic work-up of food allergy. Objective To evaluate the diagnostic capacity of the SPT in predicting the outcome of oral food challenges, and to determine decision points for the weal size and the skin index (SI) that could render double-blind, placebo-controlled food challenges unnecessary.

Methods: In 385 children (median age 22 months), 735 controlled oral challenges were performed with cow's milk (CM), hen's egg (HE), wheat and soy.

Specific oral tolerance induction with food in children: transient or persistent effect on food allergy?

Background: The standard treatment of food allergy is elimination of the incriminated food from the diet. Specific oral tolerance induction (SOTI) seems to be a promising approach for a causal treatment; however, it is unclear whether the tolerance achieved is transient or persistent. We report on a subset of three patients of a larger ongoing study who were treated successfully with SOTI treatment, but experienced a secondary loss of tolerance after a period of allergen avoidance.

Utility of the ratio of food-specific IgE/total IgE in predicting symptomatic food allergy in children.

Background: Double-blind, placebo-controlled food challenges are time-consuming, expensive and not without risk to patients. Therefore, an in vitro test that could accurately diagnose food allergy would be of great value.

Objective: To evaluate the utility of the ratio of specific immunoglobulin E (IgE)/total IgE compared with specific IgE (sIgE) alone in predicting symptomatic food allergy.

Controlled oral food challenges in children--when indicated, when superfluous?

The diagnostic work-up of suspected food allergy includes the skin prick test (SPT), the measurement of food specific immunoglobulin E (IgE) antibodies using serologic assays, and more recently the atopy patch test (APT). For specific serum IgE and the SPT, decision points have been established for some foods allowing prediction of clinical relevance in selected cases. The APT may be helpful, especially when considered in combination with defined levels of specific IgE.

How can we improve compliance in pediatric pneumology and allergology?

Not too long ago, physicians took 'compliance' or 'adherence' to mean the strict obedience of patients and parents - doing what the physician said, suggesting that the success or failure of the treatment lay entirely in the hands of the patient. But it is preferable to improve compliance rather than enforce it. As there is no single solution that will ensure compliance, several steps should be taken: (i) 'exploration' includes open questions, and allows admission of non-compliance, e.

The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges.

Background: Specific serum IgE is considered as one of the important diagnostic measures in the diagnostic work-up of food allergy.

Objective: To evaluate the role of specific serum IgE in predicting the outcome of oral food challenges, and to determine threshold concentrations of specific serum IgE that could render double-blind, placebo-controlled food challenges unnecessary.

Methods: In 501 children (median age 13 months), 992 controlled oral challenges were performed with cow's milk (CM), hen's egg (HE), wheat and soy.

Diagnostic pitfalls in food allergy in children.

Currently, the diagnostic work-up of suspected food allergy includes skin prick tests, the measurement of food specific immunoglobulin E (IgE), and the atopy patch test, and double-blind, placebo-controlled food challenges. However, all of these methods, even double-blind, placebo-controlled food challenges (DBPCFC), may sometimes be misleading. This overview describes several pitfalls for standard diagnostic methods such as problems with irritative skin reactions mimicking IgE-mediated symptoms, the problem of non-IgE-mediated reactions, pitfalls arising from the way foods are prepared or processed, effects of the route of exposure, the role of augmentation factors lowering the threshold value for clinical reactions, the noncomparability of specific IgE decision points, the influence of the timing of diagnostic measures.

Specific IgE levels do not indicate persistence or transience of food allergy in children with atopic dermatitis.

Background: Food allergy in early childhood usually resolves with time; however, little is known about predictors for persistence or transience of food allergy in children with atopic dermatitis. The aim of the study was to evaluate whether specific IgE levels in serum could be a useful predictor of the outcome of oral re-challenges.

Methods: In 74 children, 99 oral food challenges were performed (cow milk n = 48, hen egg n = 37, and wheat n = 14) and repeated after a median time interval of 16 months.

Role of oral food challenges in the diagnostic work-up of food allergy in atopic eczema dermatitis syndrome.

The diagnosis of food allergy in infants and children is still a challenging task for the pediatrician. While immediate-type allergic reactions to foods can be diagnosed quite easily, late-phase reactions, e.g.

How to enter the pediatric airway for bronchoscopy.

Background: Bronchoscopies are performed in childhood for diagnostic reasons (e.g. evaluation of stridor, unexplained cough, possible malformations) and therapeutic reasons (e.

Functional symptoms confused with allergic disorders in children and adolescents.

The diagnosis of a functional respiratory disorder is sometimes difficult and time-consuming, because the symptoms often resemble those of organic diseases. The most common entities are hyperventilation syndrome, psychogenic cough, sighing dyspnea, and vocal cord dysfunction. Typical signs are heavy breathing or dyspnea, cough or sneezing, various breathing sounds, tightness of the throat or chest, pain, and fear.

Importance of chamber size for the outcome of atopy patch testing in children with atopic dermatitis and food allergy.

Because the small backs of young children offer little space for atopy patch testing, it would be helpful to use smaller chambers. We therefore compared 6-mm chambers with the 12-mm chambers used in previous studies. We performed 55 double-blind, placebo-controlled food challenges in 30 children (17 boys, 13 girls) aged 3 to 58 months (median, 13 months).

Evolving role of the atopy patch test in the diagnosis of food allergy.

The atopy patch test has developed into a valuable additional tool in the diagnostic work-up of food allergy in infants and children with atopic dermatitis. A positive atopy patch test may help to prevent imposing restrictive and unnecessary diets after misjudging late reactions by clinical assessment alone. Furthermore, the combination of positive atopy patch tests together with defined levels of specific IgE makes double-blind, placebo-controlled food challenges superfluous in some cases.

"They don't leave you on your own:" a qualitative study of the home care of chronically ill children.

Learning to cope with a chronic illness is a process often demanding professional help that extends beyond the time spent in the hospital. Using interviews, this qualitative study describes the subjective experiences of five families with children who are chronically ill and the experiences of the two head nurses at External Care Services (EPD) in Berlin, Germany, an institution focused exclusively on home care for children. The positive experiences expressed by parents reflect the patient-oriented understanding of caring developed by the EPD, which strives for the qualified instruction of families and the building of caring relationships.

Anaphylactic reaction to lychee in a 12-year-old girl: cross-reactivity to latex?

There are very few case reports on allergic reactions to lychee in the literature - so far only in adults. We report on a 12-year-old girl who developed swelling of lips, pruritus, generalized urticaria and dyspnea 30 min after eating a raw lychee. A second event occurred after eating a piece of cake covered with a fruit cocktail.

Atopy Patch Test (APT)--its role in diagnosis of food allergy in atopic dermatitis.

During the past few years, the Atopy Patch Test (APT) has become a valuable additional tool in the diagnostic work-up of food allergy in infants and children with atopic dermatitis. A positive APT may help to prevent restrictive and unnecessary diets which may be the consequence of misjudging late reactions by clinical assessment alone. Furthermore, the combination of positive atopy patch tests together with defined levels of specific IgE (cow milk = 0.