Caregiver health-related quality of life 1 year following pediatric gastrostomy tube placement.

Introduction: Children undergoing gastrostomy tube placement often have complex medical conditions that can increase caregiver burden and decrease caregiver health-related quality of life. Our goal was to identify changes in health-related quality of life over a 12-month period in the caregivers of these patients. Methods: We performed a prospective cohort study of pediatric patients undergoing gastrostomy tube placement. Using the PedsQL 2.0 Family Impact Module, we surveyed the caregivers of these patients at baseline (prior to gastrostomy tube placement) and 1 month, 3 months, 6 months, and 12 months following gastrostomy tube placement. We administered the same survey, at baseline only, to a control group composed of caregivers of pediatric patients undergoing elective hernia repair. Results: We enrolled 130 patients undergoing gastrostomy tube placement and 35 patients undergoing hernia repair. At baseline, these caregivers had significantly lower total health-related quality of life compared to caregivers of children undergoing hernia repair (47.4 ±â€¯16.1 vs 86.0 ±â€¯15.6, P < .001). In the first year after gastrostomy tube placement, caregivers had significant increases in total health-related quality of life (P < .01) and the physical functioning (P < .05), communication (P < .05), worry (P < .05), and daily activities (P < .001) subdomains. A within-subjects analysis comparing scores at baseline and 12 months revealed a significant increase in the total health-related quality of life score over this 1-year period (60.7 ±â€¯18.9 vs 47.4 ±â€¯16.1, P < .01). The total health-related quality of life at 12 months, however, remained significantly lower compared to controls (60.7 ±â€¯18.9 vs 86.0 ±â€¯15.6, P < .001). Conclusion: Our findings highlight the ongoing caregiver burden associated with children undergoing gastrostomy tube placement and provide evidence of the need for efforts directed at caregiver support post gastrostomy tube placement.

Developmental Dysplasia of the Hip: An Examination of Care Practices of Pediatricians.

OBJECTIVE: To evaluate the decision making processes of pediatricians regarding diagnosis and management of developmental dysplasia of the hip (DDH) by conducting a survey of pediatricians in the United States. STUDY DESIGN: An electronic survey was sent to multiple American Academy of Pediatrics state chapters and academic pediatrics groups, and responses were received from pediatricians in 10 states. The survey included demographics, guideline use, clinical scenarios, and referrals/imaging practices. The number of responses to each survey question and their relative frequencies were calculated. RESULTS: We received 139 responses and included 126 in our analyses. Only 50% of the responding pediatricians (63 of 126) practiced in an institution that endorses a care pathway for DDH. Only 5.6% of the pediatricians (7 of 125) have referred patients at 12-18 months between diagnosis and management to a specialist for suspected DDH, and 9.5% (12 of 125) have referred patients between 6 and 9 months. Almost one-quarter of the pediatricians (23%; 29 of 126) cited "hip click" as an abnormality that would prompt them to refer a patient to a specialist, and 72.2% (91 of 126) indicated that family history of DDH warrants an ultrasound regardless of the physical examination findings. Moreover, 10.3% of the surveyed pediatricians (13 of 126) reported being only "somewhat" or "moderately" familiar with the Barlow and Ortolani maneuvers. CONCLUSIONS: The results of this study indicate that there is an opportunity to better distribute and implement DDH guidelines. The large number of pediatrician respondents who would not refer patients to a specialist or order imaging studies appropriately represents an opportunity for education. The implementation of a care map with standard referral and imaging practices could improve the care of patients with DDH.