A standardized treatment protocol for pilonidal disease can influence the health mindset of adolescents.

PURPOSE: Pilonidal disease (PD) significantly impacts patients' quality of life and requires regular maintenance behaviors to achieve cure. Health mindset is a psychological construct which can influence health behaviors and outcomes, with a growth mindset being associated with better outcomes than a fixed. We propose that participation in a standardized treatment protocol can affect the health mindset for adolescents with pilonidal disease. METHODS: PD patients' demographics, recurrence, and comorbidities were prospectively collected from 2019 to 2022. We assessed patients' mindset score at initial presentation using the validated Three-Item Mindset Scale (1-6) then reassessed during follow-up. t-test was used to compare baseline and follow-up mindset scores and stratified by recurrence or comorbidities. p ≤ 0.05 was considered significant. RESULTS: A total of 207 PD patients (108 males, 99 females) with mean age 18.2 ± 3.7 years were followed for 351 ± 327 days. Mean baseline mindset score (4.76 ± 1.27) was significantly lower than mean follow-up mindset score (5.03 ± 1.18, p = 0.049). Baseline mindset score was significantly lower among patients with PD recurrence (4.00 ± 0.66) compared to those without recurrence (4.8 ± 1.29, p = 0.05). Among patients with PD recurrence, mean baseline mindset score (4.00 ± 0.66) was significantly lower than mean follow-up mindset score (5.27 ± 0.93, p = 0.0038). Patient comorbidity did not affect the baseline or follow-up mindset score. CONCLUSIONS: Participation in a standardized treatment protocol is associated with the development of a stronger growth mindset over time for patients with PD. Furthermore, a growth mindset was linked to lower recurrence rate than a fixed mindset. Further investigations into how treatment approaches can work in concert with health mindset are proposed.

Comorbidities are not associated with pain symptom or recurrence in patients with pilonidal disease.

BACKGROUND: Comorbidities can potentially impact the presentation or outcome of patients with pilonidal disease (PD) due to poor wound healing or increased inflammatory response. We hypothesized that certain comorbidities could lead to worse pain or higher recurrence rate. METHODS: A retrospective study was performed on all PD patients treated with standardized minimally invasive protocol at our clinic 2019-2022. Patients' demographics, comorbidities, initial/follow-up pain score, pain duration, and recurrence were recorded. Data were analyzed by t test and Chi-square test. RESULTS: Of 207 total PD patients (108 male, 99 female), 61 had comorbidities. Mean age was 18.2 years. The recurrence rate was 7%, and patients with recurrence were significantly younger. Associated comorbidities included mood/psychiatric disorders (31%), asthma/respiratory illness (30%), obesity-related illness (15%), gastrointestinal disorders (13%), diabetes (10%), thyroid disease (8%), cardiac disease (8%), musculoskeletal/connective tissue disorders (7%), immunologic disease (7%), inflammatory bowel disease (5%), and chest wall disorders (3%). The presence of comorbidities was not associated with PD recurrence. By dividing patients into adolescents (< 18 years) and adults (≥ 18 years), we found no association between comorbidity and recurrence in either group. 55% of patients had pain as an initial symptom. The initial pain score, pain duration, and pain score at follow-up were not associated with comorbidities. The comorbidities and recurrence were not associated with patient age or sex. CONCLUSIONS: Having comorbidities was not associated with pain symptoms or recurrence in PD patients. Even though patients with recurrence were younger, there was no association between comorbidity and recurrence in either adolescents or adults.

Using a smartphone application maintains physical activity following pulmonary rehabilitation in patients with COPD: a randomised controlled trial.

BACKGROUND: Evidence suggests that patients with COPD struggle to maintain improved physical activity (PA) after completing pulmonary rehabilitation (PR). Smartphone applications (apps) providing a comprehensive training programme have conferred healthy benefits. This study was conducted to determine whether regular usage of an app maintains PA following PR. METHODS: Patients with stage II-IV COPD were enrolled in a 6-month trial following PR. After the screening period, participants were randomised into the Kaia COPD app group (intervention group (IG)) or the control group (CG). The primary outcome was PA (daily steps), measured using an activity tracker. Secondary outcomes included the COPD Assessment Test (CAT), the Chronic Respiratory Disease Questionnaire (CRQ) and the 1 min Sit-to-Stand Test (STST). RESULTS: Sixty participants completed the study. The median steps from baseline to 6 months were significantly different between the groups, in favour of the IG (-105.3, IQR -1970.1 to 2105.8, vs CG -1173.0, IQR -3813.1 to -93.8; p=0.007). CAT was significantly decreased in the IG (15.1±8.6 vs 19.7±6.4, p=0.02), whereas the CRQ subdomains for dyspnoea (4.5±1.7 vs 3.7±1.3, p=0.033) and fatigue (4.5±1.4 vs 3.5±1.3, p=0.028) improved significantly in the IG. The STST at 6 months was not significant. Sleep duration and sleep efficiency showed no significant differences between the two groups at any time. CONCLUSIONS: A comprehensive program by using the Kaia app following PR maintained PA and improved symptoms in patients with COPD at 6 months. The app might be an important accessory tool for enhanced COPD care. TRIAL REGISTRATION NUMBER: DRKS00017275.

Parental Health Mindset Is Related to Preoperative Perceptions of Chest Wall Anomalies.

INTRODUCTION: Mindsets of health have been linked to different outcomes for patients with both surgical and medical conditions. A "growth" mindset, in which health is defined as malleable and subject to improvement, is associated with improved attitudes and outcomes when compared to a "fixed" mindset, in which health is defined as unchangeable. In pediatric surgery, parental growth mindsets of health have been correlated with better postoperative outcomes, including lower scores of anxiety and pain perceptions, for children. This was particularly notable in a study of postoperative outcomes for patients with pectus excavatum. In our current study, we extend our investigations to explore how health mindsets are associated with perceptions of chest wall anomalies before correction is undertaken. METHODS: Seventy-six patients (71 males, mean age 14 y, and 43 excavatum) and 18 parents were surveyed during a routine chest wall clinic visit. Demographic and clinical information as well as the Health Mindset Scale and Pectus Excavatum Evaluation Questionnaire were administered and collected pretreatment. RESULTS: Parental mindsets of health were significantly correlated with parent assessments of their children's chest pain, physical activity, and concerns about the life-time effect of the condition. A parental growth mindset was linked to lower scores of chest pain, higher ratings of activity, and lower overall level of concern. Furthermore, parental health mindsets also significantly correlated with children's own perceptions of their chest pain, physical activity, shortness of breath, and fatigue. Growth mindset also was linked to more positive ratings. CONCLUSIONS: Parental growth mindset was associated with more positive assessments of children's symptoms and limitations due to pectus deformities than fixed mindsets. Health mindset has been linked to patient perceptions of, and outcomes for, diabetes, renal disease, allergies, scoliosis, and obesity. Further study into parental and patient mindset correlation may help elucidate factors for bracing compliance, and perhaps to better prepare children and parents for corrective surgical procedures.

Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients.

INTRODUCTION: Patients with mild pilonidal disease often experience symptom resolution without excision. We hypothesized that treating symptom-free/asymptomatic pilonidal patients with regular epilation alone had similar recurrence rate as patients who were also treated surgically. METHOD: Patient data were prospectively collected 2/2019-11/2022 at our Pilonidal Clinic. All patients received regular epilation; all patients presented before 12/2020 also underwent pit excision using trephines. Starting 1/2021, only symptomatic patients underwent pit excision; symptom-free patients at presentation received only regular epilation. Recurrence rates were statistically analyzed. RESULTS: 255 patients (male:54.4%, female:45.6%), median age 17.3years (IQR:15.8-19.1) were followed for median 612.5days (IQR:367.5-847). 44.1% identified as Hispanic, 36.5% Caucasian, 17.1% Asian, 2.4% Black. Median symptom duration at presentation was 180.5days (IQR:44.5-542.5). 160 patients were initially treated with surgical excision and regular epilation, while 95 patients with regular epilation only. The failure rate between patients who received surgical excision initially and recurred (9.4%) and patients who received epilation only and recurred (12.6%) was similar, after controlling for sex, race, age, comorbidities, skin type, hair color, hair thickness (p > 0.05). Patients who recurred after only undergoing regular epilation all underwent surgical excision, median 100days (IQR:59.5-123.5) after initial presentation. CONCLUSION: Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients.

Smartphone-based Ecological Momentary Assessment to study "scanxiety" among Adolescent and Young Adult survivors of childhood cancer: A feasibility study.

OBJECTIVE: Scan-related anxiety ("scanxiety") refers to the fear, stress, and anxiety in anticipation of tests and scans in follow-up cancer care. This study assessed the feasibility of Ecological Momentary Assessment (EMA) for real-world, real-time capture of scanxiety using patients' personal smartphone. METHODS: Adolescent and Young Adult survivors of childhood cancer were prompted to complete EMA surveys on a smartphone app three times per day for 11 days (33 surveys total) around their routine surveillance scans. Participants provided structured feedback on the EMA protocol. RESULTS: Thirty out of 46 contacted survivors (65%) enrolled, exceeding the preregistered feasibility cutoff of 55%. The survey completion rate (83%) greatly exceeded the preregistered feasibility cutoff of 65%. Participants generally found the smartphone app easy and enjoyable to use and reported low levels of distress from answering surveys. Participants reported significantly more daily fear of cancer recurrence (FCR) and negative affect in the days before compared to the days after surveillance scans, aligning with the expected trajectory of scanxiety. Participants who reported greater FCR and scanxiety using comprehensive measures at baseline also reported significantly more daily FCR around their surveillance scans, indicating validity of EMA items. Bodily threat monitoring was prospectively and concurrently associated with daily FCR, thus warranting further investigation as a risk factor for scanxiety. CONCLUSIONS: Findings indicate the feasibility, acceptability, and validity of EMA as a research tool to capture the dynamics and potential risk factors for scanxiety.

Adolescent Vaping-Associated Trauma in the Western United States.

INTRODUCTION: Electronic cigarettes (e-cigarettes) are handheld, battery-powered vaporizing devices. It is estimated that more than 25% of youth have used these devices recreationally. While vaping-associated lung injury is an increasingly recognized risk, little is known about the risk of traumatic injuries associated with e-cigarette malfunction. METHODS: A multi-institutional retrospective study was performed by querying the electronic health records at nine children's hospitals. Patients who sustained traumatic injuries while vaping from January 2016 through December 2019 were identified. Patient demographics, injury characteristics, and the details of trauma management were reviewed. RESULTS: 15 children sustained traumatic injuries due to e-cigarette explosion. The median age was 17 y (range 13-18). The median injury severity score was 2 (range 1-5). Three patients reported that their injury coincided with their first vaping experience. Ten patients required hospital admission, three of whom required intensive care unit admission. Admitted patients had a median length of stay of 3 d (range 1-6). The injuries sustained were: facial burns (6), loss of multiple teeth (5), thigh and groin burns (5), hand burns (4), ocular burns (4), a radial nerve injury, a facial laceration, and a mandible fracture. Six children required operative intervention, one of whom required multiple operations for a severe hand injury. CONCLUSIONS: In addition to vaping-associated lung injury, vaping-associated traumatic injuries are an emerging and worrisome injury pattern sustained by adolescents in the United States. This report highlights another means by which e-cigarettes pose an increasing risk to a vulnerable youth population.

Health Mindsets in Pediatric Chronic Headache.

OBJECTIVE: Given how frequently youth with chronic headache and migraine experience setbacks in treatment, identifying factors that promote coping and resilience is critical. Mindsets have gained attention as predictors of behavior and targets of intervention across contexts, including health. Health mindsets may help to explain how children with chronic pain interpret and respond to treatment. This study evaluated whether growth health mindsets might relate to adaptive outcomes in patients with chronic pediatric headache. METHODS: Participants were 88 children and adolescents (ages 10-17 years) with headache or migraine contacted following an appointment at a pediatric headache clinic, and their parent. Patients rated their beliefs about health as more fixed versus growth-oriented. They were presented with vignettes depicting hypothetical treatment setbacks and instructed to reflect upon real-life setbacks. Patients completed questionnaires about their cognitive appraisals of setbacks, coping, quality of life, life satisfaction, and functional impairment. RESULTS: The higher children rated their growth health mindsets, the less likely they were to appraise setbacks as threatening and endorse quality-of-life problems. Children with higher growth mindsets reported higher life satisfaction and lower functional disability. There was also an indirect relation between children's mindsets and coping through cognitive appraisals of setbacks as a threat, but not challenge. CONCLUSION: This research extends the health mindsets literature by contributing preliminary evidence of health mindsets as tied to adaptive outcomes in youth with chronic headache. These findings may be of interest to clinicians and parents, as health mindsets may offer an avenue by which resilience is promoted and maladaptive appraisals are minimized.

A problem at any age: a case report of congenital malrotation with bowel ischemia in an 84-year-old.

BACKGROUND: Malrotation with bowel ischemia is classically thought of as a disease of infants. However, the true prevalence of malrotation in both the pediatric and adult population is unknown due to the unclear number of asymptomatic patients. CASE PRESENTATION: A previously healthy 84-year-old man with no prior abdominal surgeries presented with an acute abdomen and was found on CT to have small bowel located in the right hemiabdomen and an abnormal SMA-SMV relationship suggestive of intestinal malrotation, as well as pneumatosis intestinalis. He underwent an exploratory laparotomy, where he was found to have a paraduodenal space which did not contain any bowel but was the likely source of an internal hernia. His duodenojejunal flexure was located to the right of the spinal column, the cecum in the left lower quadrant, a thick congenital band at the proximal jejunum, and multiple Ladd's bands at the level of the duodenum. The bowel appeared viable and a Ladd's procedure was performed. The patient had an uneventful post-operative course. CONCLUSIONS: There is a lack of guidelines regarding screening for and management of asymptomatic malrotation in older children and adults. However, the traditional thinking is that asymptomatic malrotation diagnosed after two years of age poses minimal risk. This case illustrates the potential risk of an internal hernia in the setting of malrotation at any time during one's lifetime.

Burden of pilonidal disease and improvement in quality of life after treatment in adolescents.

PURPOSE: Pilonidal Disease (PD) affects adolescents in different aspects. We hypothesized that patients with different gender, ethnicity, and age have different quality of life (QOL) measurements which could improve with minimally invasive treatment (MIT). METHODS: 131 PD patients underwent MIT (laser epilation ± trephination) from 2019 to 2021. Patients' demographics were recorded. Before and after MIT, patients received QOL questionnaire consisting of four categories: daily activities, sports participation, school/work attendance, and socializing. Data were analyzed using Student and multivariate t test. P < 0.05 was considered statistically significant. RESULTS: 101 (51 male, 50 female) patients were included. 30 patients with incomplete data were excluded. 54% of patients were < 18 years old. 47.5% were Hispanic. Median symptom duration prior to presentation was 5.4 (1.3-15) months. Prior to MIT, patients' ability to perform daily activities, participate in sports, attend school/work, and socialize was moderately or severely impacted in 66%, 57%, 45%, and 23% of respondents, respectively; after MIT, only 7%, 8%, 2%, and 4% were affected (p < 0.01). Recurrence rate was 6%. Pre-MIT, older patients and non-Hispanics reported worse impact on their QOL. Symptom duration or PD recurrence did not correlate with patient's pre- or post-MIT QOL. CONCLUSION: Patients' ethnicity and age impacted QOL in PD. All patients' QOL significantly improved with MIT. Considering the importance of socializing, playing sports, and school/work attendance in adolescents, our study highlights importance of early treatment of PD.

Reducing Piperacillin and Tazobactam Use for Pediatric Perforated Appendicitis.

BACKGROUND: Although perforated appendicitis is associated with infectious complications, the choice of antibiotic therapy is controversial. We assess the effectiveness and safety of an intervention to reduce piperacillin and tazobactam (PT) use for pediatric acute perforated appendicitis. METHODS: This is a single-center, retrospective cohort study of children 18 y of age or younger who underwent primary appendectomy for perforated appendicitis between January 01, 2016 and June 30, 2019. An intervention to decrease PT use was implemented: the first phase was provider education (April 19, 2017) and the second phase was modification of electronic antibiotic orders to default to ceftriaxone and metronidazole (July 06, 2017). Preintervention and postintervention PT exposure, use of PT ≥ half of intravenous antibiotic days, and clinical outcomes were compared. RESULTS: Forty children before and 109 after intervention were included and had similar baseline characteristics. PT exposure was 31 of 40 (78%) and 20 of 109 (18%) (P < 0.001), and use ≥ half of intravenous antibiotic days was 31 of 40 (78%) and 14 of 109 (13%) (P < 0.001), in the preintervention and postintervention groups, respectively. There was no significant difference in mean duration of antibiotic therapy (10.8 versus 9.8 d), mean length of stay (6.2 versus 6.5 d), rate of surgical site infection (10% versus 11%), or rate of 30-d readmission and emergency department visit (20% versus 20%) between the preintervention and postintervention periods, respectively. CONCLUSIONS: Provider education and modification of electronic antibiotic orders safely reduced the use of PT for pediatric perforated appendicitis.

The Influence of Health Mindset on Perceptions of Illness and Behaviors Among Adolescents.

BACKGROUND: Health mindsets can be viewed on a continuum of malleability from fixed (health cannot be altered) to growth (health can be affected by behavior). We propose that mindsets may influence the health perceptions of healthy adolescents as well as the health behaviors of adolescents with a chronic illness. METHODS: In Study 1, we surveyed healthy adolescents about their health mindsets and their judgments of illness in response to vignettes of fictional others. In Study 2, we measured the health mindsets and health behaviors of adolescents with type 1 diabetes RESULTS: In Study 1, healthy adolescents with a fixed health mindset were more likely to rate fictional others as being less healthy, less likely to recover, and more vulnerable to additional diseases. In Study 2, a growth mindset was associated with a greater frequency of glucose monitoring among younger, but not older, adolescents with type 1 diabetes. Further, growth mindset was associated with lower HbA1c levels for younger adolescents. CONCLUSIONS: Health mindsets may shape views of the implications of illness or injury for overall health and, in adolescents with a chronic condition, may interact with age to influence health behaviors and outcomes.

The impact of parental health mindset on postoperative recovery in children.

BACKGROUND: Mindset, or one's beliefs about the ability to change one's outcomes, has been studied in the educational domain but not in surgical settings. The purpose of this study was to examine the role of parental health mindset on children's recovery. METHODS: Participants were part of a larger National Institutes of Health-funded trial that included 1470 children undergoing outpatient tonsillectomy and adenoidectomy. We used measures of parental coping style (Monitor Blunter Style Scale; MBSS) and medication attitudes (Medication Attitudes Questionnaire; MAQ) to validate the Health Beliefs Scale (HBS; Criterion validity, Cohen's kappa). HBS categorizes parents as having a growth mindset, or the belief that health can be changed, or a fixed mindset, which reflects the belief that individuals cannot change their health. Next, we identified demographic and personality variables (eg, temperament, anxiety) as predictors for the HBS. Finally, we examined the relationship between the HBS with postoperative outcomes. RESULTS: Findings supported criterion validity of the HBS. Parents with a growth mindset reported seeking out more medical information (MBSS, 7.15 ± 3.32 vs 6.22 ± 3.38, P < .001, CI = -1.387 to -0.471) and reported fewer misconceptions regarding analgesic use (MAQ, 22.11 ± 4.09 vs 21.41 ± 4.25, P = .035, CI = 0.046 to 1.229). In assessing outcomes, we found that fixed-mindset parents rated their children's postoperative pain as more severe on days 1 (9.22 ± 3.82 vs 8.37 ± 3.71, P = .007, CI = 0.234 to 1.459) and 3 (8.13 ± 4.28 vs 7.27 ± 4.28, P = .007, CI = 0.094 to 1.638) and reported that their children received more doses of ibuprofen on postoperative day 1 (2.91 ± 1.24 vs 2.44 ± 1.44, P = .041, CI = 0.089 to 0.848). There was no difference in children's self-reported pain scores between groups (P = .585). CONCLUSIONS: These findings, coupled with recent mindset intervention studies in the educational space, suggest that parent mindset is an important target for clinical intervention in the context of children's surgical recovery.

Visualization of the fetal anus by prenatal ultrasound for the diagnosis of anorectal malformations: is it feasible?

PURPOSE: The goal of this study was to determine the feasibility of identifying the anal dimple (AD) on routine prenatal ultrasound. Using the presence, absence, appearance, and location of the anal dimple as an indirect sign for possible underlying anorectal malformations (ARM), we hypothesize that evaluation of the anal dimple as part of the fetal anatomic survey may increase the sensitivity in detecting less severe ARMs. METHODS: In a prospective longitudinal observational study, pregnant women who underwent prenatal ultrasound (US) at the Colorado Fetal Care Center between January 2019 and 2020 were enrolled. The variables recorded included gestational age, singleton versus multiple pregnancy, gender of the fetus, visualization of the AD, and reason for non-visualization of the AD. RESULTS: A total of 900 ultrasounds were performed, evaluating 1044 fetuses, in 372 different pregnant women. Gestational ages ranged from 16 to 38 weeks. The AD was visualized in 612 fetuses (58.6%) and not seen in 432 (41.4%). The two most common reasons for non-visualization were extremes in gestational age (n = 155; 36%) and fetal position (n = 152; 35.3%). The optimal gestational age range for AD visualization was 28-33 weeks + 6 days, with 78.1% visualization rate. CONCLUSION: Visualization of the anal dimple by ultrasound is feasible and may aid in the detection of less severe ARMs, ultimately impacting pregnancy management and family counseling. The optimal timing for anal dimple visualization is late second and third trimester.

Parental Understanding of Surgical Care in the Neonatal Intensive Care Unit.

BACKGROUND: Pediatric surgeons are routinely required to discuss complex diagnoses and treatment plans with the parents of their patients. Yet, how well this information is understood by its target audience is unknown. To explore this issue, we asked parents of postoperative neonatal intensive care unit patients to describe their children's care in a variety of domains. Our goal was to assess the degree of parental understanding and to identify factors that influenced comprehension. MATERIALS AND METHODS: Parents of neonatal intensive care unit patients who underwent a general surgical procedure were asked to complete a survey of their children's care in six domains of comprehension: name of the primary diagnosis, description of the primary diagnosis, description of the purpose of surgery, identification of surgical risks, identification of surgical benefits, and identification of concerning signs or symptoms to look for after discharge. Parental demographic factors such as age, level of education, and socioeconomic status were recorded, as was the presence of a prenatal diagnosis. RESULTS: Overall, 66% of participants described their child's primary surgical condition. Even fewer were able to describe a benefit or risk of the procedure. Parental use of outside resources to gain information was found to significantly relate to parental understanding in all domains. Parental level of education also improved comprehension. CONCLUSIONS: Parental understanding of surgical procedures, including the events leading up to and after an operation, is an important component of overall patient care. However, we were able to demonstrate that this understanding may be limited in spite of the best efforts of medical professionals. Further investigations should focus on ways in which information can be delivered more effectively to parents.

Attending Surgeons Differ From Other Team Members in Their Perceptions of Operating Room Communication.

BACKGROUND: The Joint Commission has repeatedly recognized inadequate communication as a top contributing factor to medical error in the operating room (OR). The goal of this qualitative study was to develop a deeper and more nuanced understanding of OR communication dynamics, specifically across different interdisciplinary roles and to recommend specific interventions based on these findings. METHODS: We performed a two-phase qualitative study at one academic institution to explore contributors and barriers to optimal OR communication. The first phase consisted of interviews with OR team members, including surgery and anesthesiology attending faculty and residents, medical students, and OR staff. We qualitatively analyzed the transcripts of these interviews using a deductive approach. We additionally verified the findings through subsequent focus groups. RESULTS: Most OR team members, independent of role, noted that team familiarity, clear role expectations, and formal communication are vital for effective OR communication. There was a disconnect between attending surgeons and the rest of the OR team: Whereas the majority of team members noted the importance of procedural-focused discussions, team hierarchy, and the attending surgeon's mood as major contributors to successful OR communication, the attending surgeons did not recognize their own ability to contribute to optimal OR communication in these regards. CONCLUSIONS: Although team familiarity was important to all participants in the OR, we noted that attending surgeons differed in their perceptions of OR communications from other members of the team, including attending anesthesiologists, residents, medical students, and nurses. Our findings support the need for (1) improved awareness of the impact of a team members's content and character of communication, particularly by attending surgeons; and (2) targeted initiatives to prioritize team familiarity in OR scheduling.

An ideal e-health system for pelvic floor muscle training adherence: Systematic review.

BACKGROUND: Nowadays, Pelvic Floor Muscle Training (PFMT) is a first line, level 1 evidence-based treatment for urinary incontinence (UI), but adherence to PFMT is often problematic. Today, there are several mobile applications (mApps) for PFMT, but many lack specific strategies for enhancing adherence. AIMS: To review available mApps for improvement of adherence to PFMT, and to introduce a new App so called iPelvis. METHODS: Review study all available mApps for PFMT and relevant literature regarding adherence by electronic search through the databases Pubmed, Embase, CINAHL, LILACS, PEDro, and Scielo. Based on these results, development of a mApp, called "iPelvis" for Apple™ and Android™ systems, implementing relevant strategies to improve adherence. RESULTS: Based on the current adherence literature we were able to identify 12 variables helping to create the optimal mApp for PFMT. None of the identified 61 mApps found for Android™ and 16 for Apple™ has all these 12 variables. iPelvis mApp and websites were constructed taking into consideration those 12 variables and its construct is now being subject to ongoing validation studies. CONCLUSION: MApps for PFMT are an essential part of first-line, efficient interventions of UI and have potentials to improve adherence, in case these respect the principles of PFMT, motor learning and adherence to PFMT. iPelvis has been constructed respecting all essential variables related to adherence to PFMT and may enhance the effects of UI treatment.

Female trainees believe that having children will negatively impact their careers: results of a quantitative survey of trainees at an academic medical center.

BACKGROUND: Medical training occurs during peak childbearing years. However, the intense workload, long work hours, and limited financial compensation are potential barriers to having children during this time. Here, we aimed to identify gender-based differences in beliefs and experiences of having children during graduate medical education. We hypothesized that both genders face significant challenges, but women are more likely to experience stressors related to work-family conflicts. METHODS: We administered an anonymous web-based survey to all trainees at an academic medical center. Primary outcomes were gender differences in beliefs and experiences of having children during training. Multivariate logistic regression was performed using independent variables of gender, specialty type (surgical vs. medical), and parental status. RESULTS: In total, 56% of trainees responded (60% women, 40% men; n = 435). Women were more often concerned about the negative impact of having children and taking maternity leave on their professional reputation and career. The majority of women expressed concern about the potential negative impact of the physical demands of their jobs on pregnancy. Among parents, women were more likely than men to be the primary caregivers on weeknights and require weekday childcare from a non-parent. CONCLUSIONS: Women face greater work-related conflicts in their beliefs and experiences of having a family during graduate medical education. Trainees should be aware of these potential challenges when making life and career decisions. We recommend that institutions employ solutions to accommodate the needs and wellbeing of trainees with families while optimizing training and workload equity for all trainees.

Do health beliefs affect pain perception after pectus excavatum repair?

PURPOSE: The pain experience is highly variable among patients. Psychological mindsets, in which individuals view a particular characteristic as either fixed or changeable, have been demonstrated to influence people's actions and perceptions in a variety of settings including school, sports, and interpersonal. The purpose of this study was to determine if health mindsets influence the pain scores and immediate outcomes of post-operative surgical patients. METHODS: As part of a multi-institutional, prospective, randomized clinical trial involving patients undergoing a minimally invasive pectus excavatum repair of pectus excavatum, patients were surveyed to determine whether they had a fixed or growth health mindset. Their post-operative pain was followed prospectively and scored on a Visual Analog Scale and outcomes were measured according to time to oral pain medication use. RESULTS: Fifty patients completed the Health Beliefs survey, 17 had a fixed mindset (8 epidural, 9 PCA) and 33 had a growth mindset (17 epidural, 16 PCA). Patients with a growth mindset had lower post-operative pain scores than patients with a fixed mindset although pain medication use was not different. CONCLUSION: This is the first usage of health mindsets as a means to characterize the perception of pain in the post-operative period. Mindset appears to make a difference in how patients perceive and report their pain. Interventions to improve a patient's mindset could be effective in the future to improve pain control and patient satisfaction.

Stabilization of glycemic control and improved quality of life using a shared medical appointment model in adolescents with type 1 diabetes in suboptimal control.

BACKGROUND: Declining glycemic control in type 1 diabetes (T1D) during adolescence persists despite treatment advances. Non-adherence, peer relations, diabetes burnout, risk taking, transition to autonomy, family conflict, and poor quality of life (QOL) are recognized barriers. Shared medical appointments (SMAs) in adolescent T1D may offer benefits, but data are limited. Our objective was to determine whether SMAs, with multi-component interventions utilizing multidisciplinary teams, improve glycemic control and psychosocial outcomes in poorly controlled adolescent T1D. METHODS: SMAs focused on self-management, communication skills, goal setting, glucose pattern recognition, and peer/diabetes team support. SMAs included: individual history and physical, labs, surveys, multidisciplinary educational ice breakers, group session, and individual wrap up. Outcomes were QOL, adherence, and retrospective and prospective glycemic control. Three to six subjects and families came to 3 SMAs and 1 individual appointment every 3 months over 9 months. SUBJECTS: A total of 37 English speaking subjects, ages 12-16 yrs, with T1D ≥ 1 year, and hemoglobin A1c (HbA1c) 7.5-11% enrolled. Thirty-two subjects attended 75% of visits, meeting inclusion criteria. RESULTS: HbA1c worsened in the 9 months before study (ΔHbA1c= 0.7 ± 1.2; p < 0.01), but remained stable during study (ΔHbA1c = 0.01 ± 1.2; p > 0.05). There were significant improvements in overall QOL (p = 0.005), school function (p = 0.006), psychosocial function (p = 0.008), barriers (p = 0.02), adherence (p = 0.01), and communication (p = 0.02). Improvements in school function and communication reached clinical significance. CONCLUSION: SMAs are feasible replacements to individual appointments in adolescent T1D, stabilizing glycemic control and improving QOL. Randomized controlled trials with optimizations are needed to further explore and refine this intervention.