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Clinical practice of pediatric psychology
\"Filled with vivid clinical material, this book describes effective practices for helping children and their families who are coping with chronic and acute health conditions and their treatment. Concise chapters on the psychosocial challenges associated with specific pediatric health conditions are organized around detailed case presentations. Demonstrating procedures for assessment, case conceptualization, brief intervention, and health promotion, the book highlights ways to collaborate successfully with medical providers and families. Chapters also discuss the varied roles that pediatric psychologists play in hospitals, outpatient clinics, primary care, and educational settings. Subject Areas/Keywords: adolescents, behavioral health, childhood, children, chronic, conditions, developmental disabilities, diseases, families, family, health behaviors, health promotion, health psychology, illnesses, interventions, medical disorders, pain, pediatric psychology, prevention, primary care, problems, psychological disorders, schools Audience: Clinical child and health psychologists, clinical social workers, psychiatrists, nurses, and school psychologists; also of interest to pediatricians\"--Provided by publisher.
Book
Case files : Pediatrics
\"This book presents 40 clinical cases illustrating essential concepts in pediatrics. Perfect for the clerkshop and the USMLE Step 2, each case includes an extended discussion, definitions of key terms, clinical pearls, and USMLE-style review questions. This interactive learning system helps you to learn instead of memorize.\"--BOOK JACKET.
Book
82 Assessing the usage of and barriers to using language interpretation services in a Canadian tertiary paediatric center
Abstract
Background
Canada has one of the highest immigration rates worldwide per population with roughly 447,180 permanent residents welcomed in 2022. Limited-English proficiency (LEP) populations face barriers in accessing health care with implications including delayed presentation, misdiagnosis, poor compliance, decreased patient comprehension, and adverse events. Adequate health care provider training in using language interpretation services (LIS) is crucial to improve the quality of patient care and reduce miscommunication. There is a lack of research in this area in Canadian paediatric populations.
Objectives
To identify attitudes towards and usage of LIS among health care providers in a tertiary paediatric center, as well as levels of LIS training received.
Design/Methods
An online survey was developed and distributed to paediatric health care professionals including physicians, residents/fellows, nursing staff, and allied health providers. Survey completion was anonymous and voluntary; data collection occurred from October 2022–February 2023. Descriptive statistics were used for quantitative data and thematic analysis for free text responses.
Results
345 respondents accessed the survey and 281(81%) completed it. Multiple paediatric professions were surveyed with most responses stemming from nursing staff, residents and physicians, and other allied health. 52.8% of respondents encountered a paediatric patient and/or their caregivers with a language barrier in English once per week or more. LIS were used by 53.1% of respondents once per week or more. 51.5% of respondents reported no previous training in using LIS in patient care, and 3.6% reported previous formal training. 57.9% of respondents felt LIS training was very beneficial to their role and 53.7% reported this increased their LIS usage. Overall, in-person interpreters were perceived as the most effective LIS modality followed by video and telephone interpreters. Barriers to using LIS included: inability to access desired modality and/or language; insufficient time; and lack of comfort in effective usage.
Conclusion
It was evident respondents felt LIS was integral to patient care, especially with an increasingly diverse population. Multiple barriers to using LIS were identified with likely applicability to other Canadian paediatric facilities. Suggested improvements were themed around improving LIS accessibility, improving LIS education and awareness, and increasing access to rare languages. This study has important implications for LIS and paediatric care, including informing educational and advocacy initiatives, policy change, and LIS resource allocation.
Journal Article
MON-474 Adrenal Control in Pediatric 11β-Hydroxylase Deficient CAH Patients Using Different Hydrocortisone Formulations: A Two-Patient Case Study
Abstract
Disclosure: P. Seo: None. M.M. Rutter: None. M. Yau: None.
The classical form of 11β-hydroxylase deficiency (11-β OHD) CAH is differentiated by severe hypertension due to the mineralocorticoid effect of deoxycorticosterone and hyperandrogenism. For children, the Endocrine Society recommends daily hydrocortisone (HC) at 10-15 mg/m^2/day in divided doses. As children grow, frequent biological and laboratory monitoring is needed for small-dose titrations of HC to optimize adrenal control. Oral HC tablets are not explicitly designed for children, necessitating splitting tablets or having pediatric-specific formulations compounded. This process makes it challenging to deliver consistent doses, particularly for amounts less than 5 mg. In late 2020, the US FDA approved a pediatric-specific HC formulation in oral granules, with doses as low as 0.5 mg. Objective To assess adrenal control in CAH on various formulations of HC, we retrospectively reviewed the medical records of two pediatric patients with 11-β OHD who had received different formulations of oral HC (solution, tablets, and oral granules) for up to 4.5 years. Methods We collected demographic, anthropometric, and pubertal data, laboratory results, and medication formulation and dosing over multiple time points during pediatric endocrine follow-up. Laboratory results included ACTH, androstenedione, plasma renin activity (PRA), deoxycorticosterone, and 11-deoxycortisol concentrations. Choice of HC oral formulations was based on family preference and provider recommendation. Results Patient 1 (27-53 mo) was initially prescribed HC solution at doses of 8.5 -14.3 mg/m^2/day and transitioned to granules at 41 mo at 11.7-14.6 mg/m^2/day. Adrenal control on HC solution and granules was similar on solution and granules with androstenedione of 31-56 ng/dl, PRA of 0.17-2.7 . ACTH peaked at 54.8 pg/mL at 38 mo But normalized over time. Androstenedione stayed within the normal range, while 11-deoxycortisol peaked at 232 ng/dL. PRA remained below normal, except at 41 mo. Patient 2 (5-39 mo) transitioned from HC solution at 18 mg/m^2/day to tablets at 16-19 mg/m^2/day at 9 mo and then to granules at 14 m.o. While on granules, HC doses decreased from 18.2 to 7.25 mg/m^2/day due to poor compliance. Until 30 mo, ACTH and androstenedione remained low, respectively at<6 pg/mL) and <10 ng/dL). PRA was consistently below the normal range, and 11-deoxycortisol spiked at 30 mo (2029 ng/dL) and androstenedione rose to 115 ng/dl at 39 mo. Changes in formulations were well tolerated. Conclusion The results indicate that adrenal control was influenced by factors beyond the formulation of HC. Variations in adrenal control were observed based on the dosage of HC relative to body surface area, with the total daily dose emerging as a primary determinant of adrenal regulation. Adherence with medication dosing and stressful blood draws may have contributed to poor adrenal control and should be explored further.
Presentation: Monday, July 14, 2025
Journal Article