An Interpretive Phenomenological Analysis of paediatric cardiology trainee experiences during COVID-19.

CONTEXT: Medical training during the COVID-19 pandemic has placed extra-ordinary demands on individuals within a context of rapid and iterative systems changes. The contemporaneous lived experience of trainees during this time has mainly been examined with surveys. Our study aims to provide a rich account of the experience of being a trainee during the pandemic to deepen our conceptual understanding of wellness. This holds relevance as we move away from examining the immediate innovations of the pandemic and towards long-term adjustments. METHODS: We used Interpretative Phenomenological Analysis (IPA) to explore the experiences of trainees in paediatric cardiology during the pandemic. Five trainees were purposively recruited. Initial semi-structured interviews were held during the first wave of the pandemic with follow-up interviews held during the second wave. RESULTS: Three superordinate paradoxical themes were recognised in the data: connectedness and isolation, disruption and stasis and vulnerability and strength. DISCUSSION: Disruption to routine activities of service delivery, training and home-life pervaded the pandemic and was experienced as stasis. Technology maintained the trainee's connection to the content of work but left them feeling isolated from its context. Vulnerability arose from interplay between illness, uncertainty and perception of risk, contrasted against strength drawn from compassion and the discovery of resilience. Supporting trainees as we emerge from the initial phase of the pandemic requires us to review how we understand and address wellness, including the contribution of organisational and systemic factors to its protection. Participants described varying states of impaired wellness and experienced a normalisation of aspects of vulnerability. We theorise that trainees were able to find opportunities for growth and the development of resilience within the space that this created.

Phrenic nerve injury after image-guided insertion of a tunnelled right internal jugular central venous catheter.

Central venous catheters (CVC) are now commonly inserted by radiologists. Although complications are infrequent, they must be avoided where possible and recognized when they occur. We present a 10-year-old boy who developed right hemidiaphragmatic paralysis, requiring surgical plication, following US-guided insertion of a tunnelled right internal jugular CVC. The needle trajectory for internal jugular puncture must be planned to avoid the phrenic nerve.

Diagnosis and management of pulmonary hypertension in infants with bronchopulmonary dysplasia: a guide for paediatric respiratory specialists.

Pulmonary hypertension (PH) can develop in babies with bronchopulmonary dysplasia (BPD). PH is common in those with severe BPD and is associated with a high mortality rate. However, in babies surviving beyond 6 months, resolution of PH is likely. There is currently no standardised screening protocol for PH in BPD patients. Diagnosis in this group relies heavily on transthoracic echocardiography. Management of BPD-PH should be led by a multidisciplinary team and focus on optimal medical management of the BPD and associated conditions that may contribute to PH. PH-targeted pharmacotherapies have been used in BPD-PH. To date, these have not been investigated in clinical trials and evidence of their efficacy and safety is absent. Educational aims: To identify those BPD patients most at risk of developing PH.To be aware of detection, multidisciplinary management, pharmacological treatment and monitoring strategies for BPD-PH patients.To understand the potential clinical course for patients with BPD-PH and that evidence on efficacy and safety of PH-targeted pharmacotherapy in BPD-PH is limited.

Acceptance and psychological impact of implantable defibrillators amongst adults with congenital heart disease.

BACKGROUND: The psychological impact of implantable cardioverter defibrillators (ICDs) in adults with congenital heart disease (ACHD) has not been established. OBJECTIVE: To compare device acceptance, quality of life, anxiety and depression between ACHD patients with ICDs (ICD-Congenital), with pacemakers (PPM-Congenital), with no devices (No Device-Congenital) and non-ACHD patients with ICDs (ICD-Non-Congenital). METHODS: A total of 147 ACHD and 46 non-ACHD patients (age 45.0±14.7 years, 56.5% males) completed the Florida Patient Acceptance Survey (FPAS), the 36-item Short Form Health Survey (SF-36) and Hospital Anxiety & Depression Scale (HADS). RESULTS: ICD-Congenital patients (n=59) showed lower device acceptance compared to PPM-Congenital patients (n=41), p=0.04, and reported worse quality of life (p=0.001) and higher prevalence of depression (p=0.009) when compared to No Device-Congenital (n=47) patients. ICD-Congenital and ICD-Non-Congenital patients (n=46) showed similar mental and physical health, device acceptance, anxiety and depression. Within ICD-Congenital, patients with poorest device acceptance (FPAS <67, "Non-Acceptors") showed significantly lower mental health scores (p=0.008), and higher levels of anxiety (p=0.02) and depression (p=0.01) compared to "Acceptors" (FPAS ≥67). "Non-Acceptors" were younger at survey (p=0.006), younger at ICD implantation (p=0.01) and were less likely to have received appropriate shocks (p=0.03). CONCLUSION: Younger age and lack of appropriate ICD shocks are risk factors for poor ICD acceptance. Device acceptance is lower in adults with congenital heart disease who receive an ICD than those who receive pacemakers. Appropriate screening for anxiety and depression may be warranted for ACHD patients considered for ICD implantation or already living with ICDs.

Prognostic significance of cardiac magnetic resonance imaging in children with pulmonary hypertension.

BACKGROUND: There are very few validated prognostic markers in pediatric pulmonary hypertension. Cardiac MRI is a useful, noninvasive method for determining prognosis in adults. The present study is the first to assess its prognostic value in children. METHODS AND RESULTS: A total of 100 children with pulmonary hypertension (median, 10.4 years; range, 0.5-17.6 years) were evaluated (idiopathic, n=60; repaired congenital heart disease, n=22; miscellaneous, n=18). In all patients, ventricular volumes and great vessel flow were measured. Volumetric data were obtained using retrospectively gated cine imaging (n=37) or real-time imaging (n=63), depending on the patient's ability to hold his or her breath. During a median follow-up of 1.9 years, 11 patients died and 3 received lung transplantation. Of the cardiac MR parameters measured, right ventricular ejection fraction and left ventricular stroke volume index were most strongly predictive of survival on univariate analysis (2.6- and 2.5-fold increase in mortality for every 1-SD decrease, respectively; P<0.05). These results were reflected in good separation of tertile-based Kaplan-Meier survival curves for these variables. CONCLUSIONS: Cardiac MR measures correlate with clinical status and prognosis in children with pulmonary hypertension. Cardiac MR is feasible and may be useful in clinical decision making in pediatric pulmonary hypertension.