The information sources and journals consulted or read by UK paediatricians to inform their clinical practice and those which they consider important: a questionnaire survey

Background  

Implementation of health research findings is important for medicine to be evidence-based. Previous studies have found variation in the information sources thought to be of greatest importance to clinicians but publication in peer-reviewed journals is the traditional route for dissemination of research findings. There is debate about whether the impact made on clinicians should be considered as part of the evaluation of research outputs. We aimed to determine first which information sources are generally most consulted by paediatricians to inform their clinical practice, and which sources they considered most important, and second, how many and which peer-reviewed journals they read.     

Timely diagnosis of comorbid pervasive developmental disorder and bipolar disorder

Little is known about the overlapping symptoms and comorbidity of pediatric bipolar disorder (BD) and pervasive developmental disorders (PDD) in youth. The aim of this study was to clearly differentiate the symptoms, understand the prevalence and patterns of comorbid presentations, as well as to provide a summary of evidence-based research findings to improve timely diagnosis and treatment for comorbid PDD and BD in children and adolescents, and to provide clinicians with evidence-based research findings of the similarity and differences in symptom presentation, the epidemiology, and diagnostic strategies used by experts in the fields of PDD and pediatric BD. The sources for this study were published review and research articles. According to the results obtained, it can be observed that studies evaluating the epidemiology, symptom presentation and diagnosis of comorbid BD and PDD are limited. However, research studies identified a clear overlap in symptoms between the two disorders and the existence of comorbid PDD and BD. Children with PDD and comorbid BD may be significantly impaired. More extensive research is needed to facilitate timely diagnosis and treatment to improve quality of life and outcomes in this population.     

From research to clinical practice: considerations in moving research into people's hands. Personal reflections that may be useful to others

It may take many years for published clinical research findings to be found, understood, adopted and applied in practice. In recognition of this delay, many jurisdictions and agencies are now promoting a stronger link between research and its dissemination in useable forms that will enable practitioners to access, understand and use new ideas. The purpose of this paper, first presented as a keynote address at the 15th Annual Meeting of the European Academy of Childhood Disability in Oslo in October 2003, is to share experiences of the author and his colleagues at a childhood disability system-linked research centre in Ontario, Canada. The lessons learned include the value of striving to describe one's findings in plain language; writing study reports for parents and children who are involved in research studies; using multiple methods to disseminate one's work; and making explicit the potential importance and applicability of the findings to readers of the work. Engaging end users at many stages of the development and field testing of one's work will enhance buy-in and lend added credibility to the work, as well as influencing content and process as the research unfolds. The result is likely to be greater recognition of 'familiar' aspects of the research and the adoption of relevant findings.     

The Pediatric Emergency Care Applied Research Network and Knowledge Translation

After 17 years, the Pediatric Emergency Care Applied Research Network has demonstrated its significant contribution to the care of acutely ill and injured children through the successful completion of more than 35 research studies. Despite the importance of research findings and the numerous publications in medical journals, the information is not easily accessible by parents, families, or nonresearch medical providers. Another group of investigators has developed knowledge translation and dissemination using social media through the Translating Emergency Knowledge for Kids knowledge mobilization network. This model is an example for other networks and outlines the challenges of dissemination of findings. The network’s research is widely published and has been incorporated into national guidelines, but the Pediatric Emergency Care Applied Research Network’s next challenge is translation of network findings into practice so every child who seeks emergency care in the United States in large or small emergency departments can be treated with evidence-based medicine.     

Editorial: Data repositories,registries, and standards in the search for valid and reproducible biomarkers

The paucity of major scientific breakthroughs leading to new or improved treatments, and the inability to identify valid and reproducible biomarkers that improve clinical management, has produced a crisis in confidence in the validity of our pathogenic theories and the reproducibility of our research findings. This crisis in turn has driven changes in standards for research methodologies and prompted calls for the creation of open‐access data repositories and the preregistration of research hypotheses. Although we should embrace the creation of repositories and registries, and the promise for greater statistical power, reproducibility, and generalizability of research findings they afford, we should also recognize that they alone are no substitute for sound design in minimizing study confounds, and they are no guarantor of faith in the validity of our pathogenic theories, findings, and biomarkers. One way, and maybe the only sure way, of knowing that we have a valid understanding of brain processes and disease mechanisms in human studies is by experimentally manipulating variables and predicting its effects on outcome measures and biomarkers.     

Patient Safety and Human Factors in Pediatric Cardiac Surgery

The patient safety movement and human factors studies are becoming an increasingly important part of everyday clinical practice. Pediatric cardiac surgery is a high-risk field that is very much dependent on safe practices and continuous research into improvement of outcomes. This article reviews the main research frameworks, methods used, and current findings in the area of patient safety and human factors within pediatric cardiac surgery.     

International patterns of the prevalence of pediatric asthma the ISAAC program

Like so much research, the findings from the ISAAC program have raised more questions than they have answered. Despite their limitations, the ISAAC findings provide the basis for further studies to investigate factors that potentially contribute to these international patterns and may lead to novel public health and pharmacologic intervention strategies that reduce the prevalence and severity of asthma worldwide.     

Research endeavors among pediatric nurse practitioners (REAP) study.

INTRODUCTION: The purpose of this study was to identify the facilitators of and barriers to research utilization and to identify research activities and resources needed to promote research among pediatric nurse practitioners. METHOD: A random sample of 10% of the NAPNAP membership (n = 627) was surveyed with a response rate of 69% (n = 431). The survey included the BARRIERS Scale to identify facilitators of and barriers to research utilization, questions about research activities, and resources needed to promote research. RESULTS: Barriers to research included time constraints for reading and implementing research, the amount of research information and the way it is compiled, and knowledge deficits about statistical analysis interpretation. Facilitators of research utilization included having time to review and implement findings, authority to change nursing practice based on research findings, and conducting clinically relevant studies. Time constraints (82%), lack of grant writing skills (66%), and funding (57%) were identified as barriers to conducting research. DISCUSSION: Findings from this study will be used by the National NAPNAP Research Committee to plan and implement programs to increase the utilization of nursing research in clinical practice and provide guidance, education, and support to promote involvement in research activities among the membership.     

Adherence to antiretroviral therapy for pediatric HIV infection: a qualitative systematic review with recommendations for research and clinical management

Although nonadherence to prescribed therapies is widespread, it is particularly problematic with highly active antiretroviral therapy for HIV infection. This review of >50 studies in the area of pediatric HIV infection revealed varying methods for assessing antiretroviral adherence with a wide range of estimates of adherence. Correlates of adherence could be grouped as those relating to the medication, the patient, and the caregiver/family, with many conflicting findings and a lack of theory guiding the research. Only 8 studies, mainly small feasibility or pilot investigations, evaluated highly active antiretroviral therapy adherence interventions in pediatric populations. We conclude with specific recommendations for assessment and clinical management of adherence and discuss directions for future research in this area.     

Fibroblast growth factor receptor mutations and craniosynostosis: Three receptors,five syndromes

The post eighteen months have been exciting time for craniosynostosis research. In a rapid flurry of publications, mutations of fibroblast growth factor receptors (FGFRs) have been identified in three of the best known craniosynostosis syndromes, namely Apert, Crouzon and Pfeiffer syndromes, as well as in Jackson-Weiss syndrome and thanatophoric dysplasia. These findings open many new avenues for craniosynostosis research including studies of diagnosis, pathogenesis, and mutagenesis. Here the major findings and their implications have been briefly reviewed.     

Psychological effects of earthquakes in children: prospects for brief behavioral treatment

Background  Treatment of child earthquake survivors is a relatively less investigated issue in disaster research. A review of the evidence on the mental health effects of earthquakes, risk factors, and findings from treatment studies may provide useful insights into effective treatment of traumatized children. Data sources  Studies of child and adolescent earthquake survivors included the PILOTS database (electronic index for literature on psychological trauma) and relevant evidence from various studies of adult earthquake survivors. Results  Evidence points to elevated rates of posttraumatic stress disorder (PTSD), depression, and earthquake-related fears in children and adolescents. Traumatic stress appears to be mediated by loss of control over fear induced by exposure to unpredictable and uncontrollable earthquakes. This implies that interventions enhancing sense of control over fear are likely to be most effective. Recent studies indeed show that a control focused behavioral treatment (CFBT) involving mainly encouragement for self-exposure to feared situations is highly effective in facilitating recovery from earthquake trauma. Evidence also suggests that CFBT can be delivered through booklets and similar media. Conclusions  Pilot studies suggest that CFBT has promise in effective treatment of PTSD in children. Further research is needed to confirm these preliminary findings and to develop self-help tools for children.     

Are findings from large longitudinal studies of child health and development useful or just of interest?

In this paper I outline the different types of birth and pre-birth cohort studies that exist, with their advantages and disadvantages, before describing the ways in which such studies can answer research questions that would not be feasible with retrospective case-control studies. Details of some of the findings from birth cohort studies are described, together with some of the health benefits of putting the results into practice.     

Practitioner Review: Posttraumatic stress disorder and its treatment in children and adolescents

Important advances in understanding traumatic stress reactions in children and young people have been made in recent years. The aim of this review was to synthesise selected recent research findings, with a focus on their relevance to clinical practice. We therefore address: findings on the epidemiology of trauma exposure and Posttraumatic Stress Disorder (PTSD); recent changes to diagnostic classification; implications for screening and assessment of traumatic stress reactions; and treatment outcome studies including interventions for acute and chronic PTSD, dissemination of effective treatments into community settings, and early interventions. We conclude with recommendations for clinical practice and suggestions for future areas of research.     

Neuromotor Outcomes of Infants Exposed Prenatally to Cocaine:

The effect of prenatal cocaine exposure on the neuromotor outcome of infants has been investigated through animal research, neurophysiological studies of neonates, and longitudinal follow-up of exposed infants. The inconsistency in reported findings may reflect methodological problems as well as variations among study populations and individual infants. Several studies using the Movement Assessment of Infants (MAI) have reported significant differences in motor performance at four months of age in infants who were cocaine-exposed prenatally, but specific clinical findings vary. A review of relevant work is presented here with a discussion of issues and variables which must be considered in an evaluation of the neuromotor consequences of intrauterine cocaine exposure for the developing infant.     

Fibrodysplasia ossificans progressiva: Review and research activities in Japan

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic skeletal disorder manifesting progressive heterotopic ossification (HO) and congenital malformation of the great toes. Since 2007, we have conducted research on FOP. Here, we review the findings on FOP published to date, including the results of our research. Epidemiological studies in Japan have indicated that FOP has nearly the same prevalence in Japan as in the rest of the world. Basic research on its pathoetiology has progressed rapidly since the identification of the causal gene in 2006. Clinical and radiological findings have been thoroughly researched, including early radiological signs, and diagnostic criteria were established, designating FOP as an intractable disease in Japan. In patients with FOP, the progression of HO is associated with numerous disabilities, often manifesting in vicious cycles that can lead to early mortality. Through cross‐sectional and short‐term longitudinal studies, we have explored patient education, quality of life, and activities of daily living among Japanese patients. The management of FOP requires education of patients and caregivers, the use of medications to settle inflammation and flare‐ups, instructions to ensure proper oral care, and other compensatory approaches that aid in rehabilitation. An avoidance of medical intervention, which may cause HO to progress, is also important. The advent of new drugs to prevent HO could have clinical benefit.     

Reading the signs of starvation

Guidelines for managing malnutrition in adolescent eating disorders are based on limited evidence. Swenne and Engström's study explored the relationship between symptoms, signs and weight status in this patient group, towards refining clinical approaches to nutritional assessment in adolescents. Conclusion: The need to compare findings across studies is crucial for research in nutritional assessment of adolescents.     

Normal studies are essential for objective medical evaluations of children who may have been sexually abused

The findings of carefully conducted research studies of non-abused children should be used in medical evaluations for suspected sexual abuse if they are to be legally defensible. These studies have shown that a “wide” hymenal opening and a “narrow” rim of hymen should not be used as markers of abuse.

Conclusion: The study by Myhre and associates is another addition to a growing collection of good science in a field of medicine where objectivity is essential.     

Pediatric transplantation of the kidney, liver and heart: summary report

The following is a summary report of an extensive review of the literature from 1966 to 2001 on growth and development in children receiving kidney, liver and heart transplants. The literature was assessed for relevancy to current clinical practice and for reliability and generalizability of the inferences based on the study design, controls, sample size, age distribution, confounding factors, use of standardized instruments, and consistency with other findings. While studies on growth are included in the review, the main emphasis is on research in cognitive and psychosocial development since these areas have been far less thoroughly studied and contain various methodological deficiencies. On the basis of the literature review both general methodological recommendations and specific recommendations for future research studies are made. Access to the full is provided on the World Wide Web at http://light.emmes.com/pedstransplantation/.     

Cognitive outcomes in school-age children born prematurely

The purpose of this article is to discuss findings in the literature regarding long-term developmental outcomes of infants born prematurely, to examine potential causes of individual differences in these outcomes, and to explore directions for future research. An extensive table summarizes recent (1996-2002) international studies of developmental outcomes among children of school age and older who were born with low birth weight, especially as the studies relate to cognitive development and academic performance. The discussion then examines how characteristics of the child and the environment may interact to produce individual differences in outcomes. Processes of attention regulation within the context of the psychosocial environment are examined as an important possible direction for future research. When designing and implementing interventions aimed at improving outcomes in this and other groups of children at risk for delays and deficits, it is important to consider how various factors affect development.     

Spectrum of intracranial incidental findings on pediatric brain magnetic resonance imaging: What clinician should know?

Intracranial incidental findings on magnetic resonance imaging (MRI) of the brain continue to generate interest in healthy control, research, and clinical subjects. However, in clinical practice, the discovery of incidental findings acts as a “distractor”. This review is based on existing heterogeneous reports, their clinical implications, and how the results of incidental findings influence clinical management. This draws attention to the followings: (1) the prevalence of clinically significant incidental findings is low; (2) there is a lack of a systematic approach to classification; and discusses (3) how to deal with the detected incidental findings based a proposed common clinical profile. Individualized neurological care requires an active discussion regarding the need for neuroimaging. Clinical significance of incidental findings should be decided based on lesion’s neuroradiologic characteristics in the given clinical context. Available evidence suggests that the outcome of an incidentally found “serious lesion in children” is excellent. Future studies of intracranial incidental findings on pediatric brain MRI should be focused on a homogeneous population. The study should address this clinical knowledge based review powered by the statistical analyses.