Pediatric Osteopathic Manipulative Medicine: A Scoping Review.

CONTEXT: A common reproach precluding the use of osteopathic manipulative medicine (OMM) in pediatrics is a lack of evidence regarding its safety, feasibility, and effectiveness. OBJECTIVE: We conducted a systematic, scoping review of pediatric osteopathic medicine to identify gaps in the literature and make recommendations for future research. DATA SOURCES: We searched 10 databases using 6 key words and medical subject heading terms for any primary articles reporting OMM use in children published from database inception until initiation of the study. STUDY SELECTION: Articles were selected if they reported primary data on OMM conducted in the United States on patient(s) 0 to 18 years old. DATA EXTRACTION: Baseline study characteristics were collected from each article and the Grading of Recommendations, Assessment, Development, and Evaluations system was used to critically appraise each study. RESULTS: Database search yielded 315 unique articles with 30 studies fulfilling inclusion and exclusion criteria. Of these, 13 reported the data required to demonstrate statistically significant results, and no significant adverse events were reported. The majority of studies were graded as providing weak clinical evidence because of significant methodologic flaws and biases. LIMITATIONS: The review was limited to US-based studies and reports. Minimal discrepancies between reviewers were resolved via an objective third reviewer. CONCLUSIONS: There is little strong, scientific, evidence-based literature demonstrating the therapeutic benefit of OMM for pediatric care. No strong clinical recommendations can be made, but it can be medically tolerated given its low risk profile. High-quality, scientifically rigorous OMM research is required to evaluate safety, feasibility, and efficacy in pediatrics.

Mindful Mentors: Is a Longitudinal Mind-Body Skills Training Pilot Program Feasible for Pediatric Cardiology Staff?

BACKGROUND: Stress and burnout among medical professionals are common and costly, placing professionals, organizations, and patients at risk. OBJECTIVES: To determine feasibility and acceptability of a longitudinal mind-body skills training initiative to help staff decrease stress and burnout, improve well-being, and empower them to utilize basic mindfulness methods with coworkers, patients, and families. METHODS: Prospective cohort, mixed methods approach. Nurses, doctors, technicians, social workers, child life specialists were eligible to participate. The 12-month curriculum consisted of 16 hours of intensive education/practice over 2 days, with training in mindfulness skills, self-compassion, nonviolent communication, overcoming barriers to practice, and mindful listening/speaking, followed by monthly 1 hour booster/debriefing sessions. RESULTS: A total of 37 staff participated (RN = 18, MD = 5, Technician = 6, Social Worker = 3, Child life = 3, others = 2) in the initial training, and 24 (65%) completed the 3- and 12-month follow-up surveys. Compared with pretraining scores, there were significant improvements 3 to 12 months after the initial training in stress (P < .0001), distress (P ≤ .04), anxiety (P = .01), self-efficacy in providing non-drug therapies (P < .0001), mindfulness (P = .002), burnout (P < .0001), and confidence in providing compassionate care (P < .0001). In addition, 25 (67%) participants initiated projects incorporating what they learned into staff/patient wellness activities. CONCLUSION: This longitudinal pilot program was feasible and was associated with improvements in measures of psychological well-being over the 12-month intervention. The innovative approach of training participants to teach basic techniques to coworkers and other staff can increase the impact of this program beyond any individual participant. Future research will investigate the aspects of implementation and potential effects on patient care and experience.

Burnout in Pediatric Residents: Three Years of National Survey Data.

BACKGROUND: We aimed to describe the national epidemiology of burnout in pediatric residents. METHODS: We conducted surveys of residents at 34 programs in 2016, 43 programs in 2017, and 49 programs in 2018. Survey items included the Maslach Burnout Inventory, demographics, program characteristics, personal qualities, experiences, and satisfaction with support, work-life balance, and learning environment. Analyses included cross-sectional comparisons and cross-sectional and longitudinal regression. RESULTS: More than 60% of eligible residents participated; burnout rates were >50% in all years and not consistently associated with any demographic or residency characteristics. Cross-sectional associations were significant between burnout and stress, sleepiness, quality of life, mindfulness, self-compassion, empathy, confidence in providing compassionate care (CCC), being on a high-acuity rotation, recent major medical error, recent time off, satisfaction with support and career choice, and attitudes about residency. In cross-sectional logistic regression analyses, 4 factors were associated with an increased risk of burnout: stress, sleepiness, dissatisfaction with work-life balance, and recent medical error; 4 factors were associated with lower risk: empathy, self-compassion, quality of life, and CCC. Longitudinally, after controlling for 2017 burnout and 2018 risk factors (eg, recent error, sleepiness, rotation, and time off), 2017 quality of life was associated with 2018 burnout; 2017 self-compassion was associated with lower 2018 stress; and 2017 mindfulness, empathy, and satisfaction with learning environment and career choice were associated with 2018 CCC. CONCLUSIONS: A majority of residents met burnout criteria. Several identified factors (eg, stress, sleepiness, medical errors, empathy, CCC, and self-compassion) suggest targets for interventions to reduce burnout in future studies.

Setting a research agenda for pediatric complementary and integrative medicine: A consensus approach.

BACKGROUND: Pediatric use of complementary medicine (CM) is common and offers numerous research questions about diverse therapies and conditions. Although research priorities for pediatric CM have been identified, there was a need to update in light of the rapid evolution of the field. METHODS: Building on previous work, we conducted an international, consensus-based 4-step modified Delphi process to develop and refine a pediatric CM research agenda, including on-line questionnaires and an in-person meeting. Participants included health care professionals, researchers, and educators. RESULTS: We received 376 responses; participants included conventional and CM providers, researchers, educators, administrators, and policy-makers from 15 countries (Australia, Bangladesh, Belgium, Canada, China, Germany, India, Israel, Italy, New Zealand, Norway, Sri Lanka, The Netherlands, United Kingdom, and United States). While it was recognized that each region must set their own priorities based on use, access, and expertise, a "minimum set" for a pediatric CM research agenda was identified. After three rounds of surveys, participants identified the highest priorities for pediatric CM research as: (i) safety of CM therapies for infants, children, and adolescents; (ii) conditions for which CM use is highly prevalent and for which conventional medicine lacks safe, cost-effective therapies; iii) therapies/therapists to be examined for quality and reproducibility of interventions, comparative and cost effectiveness, dose, etc.; and iv) identification of relevant outcomes and outcome measurement tools. CONCLUSIONS: The results of our study identify that "first do no harm" is the leading research priority for pediatric CM research, followed by more research on effectiveness of CM therapies for conditions not safely and effectively treated with conventional care. In order to improve pediatric health care, interdisciplinary collaborative approaches are needed between CM and conventional providers and researchers.