Effect of CPAP on airway reactivity and airway inflammation in children with moderate-severe asthma

BACKGROUND AND OBJECTIVE: Asthma is characterized by airway hyperreactivity and airway inflammation. We previously demonstrated that adults with mild well-controlled asthma exhibited a marked decrease in airway reactivity (PC20 increased >2-fold) after using nocturnal continuous positive airway pressure (CPAP) for 1 week. If CPAP produces a similar suppression of airway reactivity in children with moderate-severe asthma, who require chronic use of corticosteroids, then this non-pharmacological therapy might provide a beneficial alternative or supplemental therapy in these subjects. METHODS: Children aged 8-17 years with moderate-severe asthma were treated with 4 weeks of nocturnal CPAP (8-10 cm H2 O) or sham CPAP (<2 cm H2 O). Adherence was monitored with a modem installed in the equipment or by memory cards. Airway reactivity, assessed by methacholine bronchial challenge, was measured prior to and following treatment. RESULTS: The percentage of subjects adherent to treatment was similar in both groups (19/27 CPAP vs 19/28 sham, ~70%). There was a tendency for PC20 to increase with treatment in both groups (3.0-5.3 mg/mL CPAP vs 3.2 to 4.3 mg/mL sham, P = 0.083); however, the change did not differ significantly between groups (P = 0.569). CONCLUSION: We found that the 4-week treatment with nocturnal CPAP did not produce a twofold suppression of airway reactivity in children with moderate-severe asthma

Pediatric pulmonology year in review 2020: Physiology

Pulmonary physiology is a core element of pediatric pulmonology care and research. This article reviews some of the notable publications in physiology that were published in Pediatric Pulmonology in 2020

Determining the Needs for Pediatric Diabetes Education among Nurses

INTRODUCTION: Inpatient management of children and adolescents with diabetes requires a cohesive multidisciplinary team confident in the needs of patients requiring insulin. Previous studies have reported diabetes-related knowledge deficiency in adult-medicine nurses, however there is limited literature in pediatric nurses. Other researchers have trialed various diabetes education (DiabEd) programs in small cohorts and encountered barriers with study retention. At our hospital, pediatric patients with diabetes are often, but not always, admitted to a specific unit (8 East, 8E), which may lead to unequal experience in nurses caring for these children on other units. OBJECTIVE: Our objective was to measure the previous experience, training, comfort, and knowledge of pediatric nurses related to insulin and diabetes care. We also sought to understand the distribution of patients with insulin needs across units of the hospital. METHODS: A needs assessment was conducted with surveys to nursing representatives, review of diabetes resources available on each unit, and data surrounding insulin usage and incident reports pertaining to diabetes or insulin. Surveys consisted of six questions regarding current DiabEd provided for nurses and interest in further DiabEd. A pretest consisted of 2 validated tools: a modified Diabetes Self-Report Tool (mDSRT) and modified Diabetes Knowledge Test 2 (mDKT2). The mDSRT used a 4-point Likert scale for 10 items covering confidence in aspects of inpatient diabetes care, with higher scores reflecting higher confidence. The mDKT2 consisted of 15 multiple choice questions. RESULTS: Of 8 non-acute care units (nonACUs) evaluated, 25% had standard diabetes-specific training for new nurses and none had ongoing education after orientation. Seven units expressed the desire for additional DiabEd. Unit resources were out-of-date and 63% of nonACUs lacked any physical resources. Although nonACUs outside of 8E were responsible for only 16% of insulin usage in the hospital over the prior 24 months, they were referenced in 29% of incident reports. Of 47 nurses who completed the pretest, 13 (28%) missed >1 hypoglycemia-related question and 31 (66%) missed >1 ketone-related question. Of all survey responders, 22 (45%) reported receiving no DiabEd in the prior 2 years, 86% of whom had taken care of patients with diabetes in that timeframe. There were no differences in mDKT2 scores between nurses who had received DiabEd within the last 2 years (12.9+/-1.4) and those who had not (12.8+/-1.8, p=0.812). Nurses on 8E scored higher on the mDSRT (3.6+/-0.5, n=5) compared to nurses on other nonACUs (2.9+/-0.5, n=44; p=0.004). There was a positive correlation between mDSRT and mDKT2 scores (p<0.001, r=0.512), representing higher confidence with higher diabetes knowledge scores. CONCLUSION: The needs assessment and pretest data are consistent with previous studies in adult-medicine nurses and support the need for ongoing DiabEd for pediatric nurses. To our knowledge, this is the first study to evaluate educational needs of nurses related to diabetes care in children and adolescents and to create a curriculum to meet those needs. From these findings, a new DiabEd curriculum was developed and is currently implemented, with posttest data planned

Incorporating a Three-Dimensional Printed Airway into a Pediatric Flexible Bronchoscopy Curriculum

Background: Although hands-on simulation plays a valuable role in procedural training, there are limited tools available to teach pediatric flexible bronchoscopy (PFB). Fellowship programs rely on patient encounters, with inherent risk, or high-cost virtual reality simulators that may not be widely available and create education inequalities. Objective: Our objective was to study the educational value and transferability of a novel, low-cost, three-dimensional-printed pediatric airway model (3D-AM) for PFB training. Our central hypothesis was that the 3D-AM would have high educational value and would be easily transferrable to learners at different teaching hospitals. Methods: The 3D-AM was designed to teach technical bronchoscopy skills, airway anatomy, airway pathology, and bronchoalveolar lavage (BAL). The curriculum was offered to incoming fellows in pediatric pulmonology, pediatric surgery, and pediatric critical care across three different teaching institutions. After course completion, each participant assessed the simulation model(s) with a 5-point Likert scale across six domains: physical attributes, realism of experience, ability to perform tasks, value, relevance, and global impression. The expert instructors assessed the learners' competency using a modified version of the Bronchoscopy Skills and Tasks Assessment Tool. Results: A total of 14 incoming fellows participated in the course. The mean scores for the 3D-AM across all six domains and across the three institutions was between 4 and 5, suggesting that learners generally had a favorable impression and a similar experience across different institutions. All learners "agreed" or "strongly agreed" that the course was a valuable use of their time, helped teach technical skills and airway anatomy, and would be useful for extra training during fellowship. Most of the learners correctly identified anatomy, bronchomalacia, and performed a BAL. Wall trauma was observed in 36% of learners. Conclusion: The utility, low cost, and transferability of this model may create opportunities for PFB training across different institutions despite resource limitations in the United States and abroad