Social Deprivation Is Associated With Lower Access to Pre-emptive Kidney Transplantation and More Urgent-Start Dialysis in the Pediatric Population

Introduction Socioeconomic status (SES) is recognized as an important determinant of kidney health. We aimed to evaluate the association of social deprivation with different indicators at kidney replacement therapy (KRT) initiation in the French pediatric metropolitan population. Methods All patients with end-stage kidney disease (ESKD) who started KRT before 20 years old in France between 2002 and 2015 were included. We investigated different indicators at KRT initiation, which are as follows: KRT modality (dialysis vs. pre-emptive transplantation), late referral to a nephrologist, and dialysis modality (hemodialysis [HD] vs. peritoneal dialysis [PD], urgent vs. planned start of dialysis, use of catheter vs. use of fistula for HD vascular access). An ecological index (European Deprivation Index [EDI]) was used as a proxy for social deprivation. Results A total of 1115 patients were included (males 59%, median age at dialysis 14.4 years, glomerular/vascular diseases 36.8%). The most deprived group represented 38.7% of the patients, suggesting pediatric patients with ESKD come from a more socially deprived background. The most deprived group was more likely to initiate KRT with dialysis versus kidney transplantation. Among patients on HD, the odds of starting treatment in emergency with a catheter was >2-fold higher for the most deprived compared with the least deprived children (adjusted odds ratio [aOR] 2.35, 95% CI 1.16–4.78). Conclusion Children from the most deprived area have lower access to pre-emptive transplantation, have lower access to PD, tend to be late referred to a nephrologist, and have more urgent initiation of HD with a catheter

C3 Glomerulopathy : a french pediatric series

REIMS-BU Santé (514542104) / SudocSudocFranceF

Le syndrome orellanien : cause rare d'insuffisance rénale aiguë de l'enfant

REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Intérêt du dosage de la lipoprotéine(a) dans le syndrome néphrotique idiopathique cortico-sensible de l'enfant

REIMS-BU Santé (514542104) / SudocSudocFranceF

Evaluation du protocole de prise en charge des infections urinaires fébriles aux urgences pédiatriques du CHU de Reims

REIMS-BU Santé (514542104) / SudocSudocFranceF

Glomérulonéphrite aiguë post-streptococcique chez l'enfant en Polynésie Française

REIMS-BU Santé (514542104) / SudocSudocFranceF

Hétérogénéité physiologique de l'épithélium de l'épididyme : sécrétion de protons via la H+-ATPase vacuolaire dans les cellules claires et transport d'eau et de solutés via l'aquaporine 9 dans les cellules principales

REIMS-BU Santé (514542104) / SudocSudocFranceF

Le syndrome hyper IgD

REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Impact of training in the supervision of clinical reasoning in the pediatric emergency department on residents’ perception of the on-call experience

Background: In 2021, the prevalence of signs of burnout among medical residents was reported to be 67%. Being on call is particularly stressful for residents, notably due to their lack of medical experience. When they are on call, several factors contribute to a mismatch between the residents' theoretical knowledge and the operationalization of that knowledge in a clinical reasoning process. Using the script and cognitive load theories as a basis, we hypothesized that training clinician-teachers in the supervision of clinical reasoning could improve residents' perception of the experience of being on call. Methods: We performed a longitudinal, exploratory, controlled study with a cohort of medical residents who were on call in the pediatric emergency department during the semester from 1 November 2021 to 30 April 2022. During the night, the residents on call in the pediatric emergency department completed validated questionnaires investigating (1) mental effort, (2) cognitive weariness, (3) state anxiety, (4) feeling of self-efficacy, and (5) well-being. We compared the questionnaires of residents supervised by pediatricians trained in the supervision of clinical reasoning (supervision group) with those of residents in a control group, supervised by pediatricians with no specific pedagogical training. Results: A total of 284 questionnaires (174 supervision group, 110 controls) were collected from 38 residents in three pediatric emergency departments. The results confirm that being on call is difficult for residents. Compared to the control group, residents in the supervision group had lower cognitive weariness scores (mean 3.0 ± 1.1 vs. 3.5 ± 1.3). There was no significant difference between groups for any of the other dimensions of the on-call experience. In the supervision group, mental effort was significantly lower at the end of the study semester (5 [5-6] when on call in month 6 of the semester vs. 6 [5-7] when on call in months 1-5 of the semester; p = 0.01) and was greater for more senior residents (7 [6-8] for those in the 4th or higher semester of residency vs. 6 [5-7] for residents in their 1st, 2nd, or 3rd semester of residency; β = 0.92 ± 0.40; p = 0.02). Conclusion: Beyond the positive effects for residents, this study illustrates the feasibility of implementing training for clinicians in the supervision of clinical reasoning.</p