Background: Plain abdominal X-rays are used in the evaluation of children with constipation. However, their clinical utility has not been established. Aim: To assess the accuracy of different scoring methods in identifying children with functional constipation. Methods: Retrospective review of abdominal x-rays in which colonic transit (CT), Barr, Leech and fecal loading (FL) scores were blindly measured by pediatric gastroenterologists and a radiologist. Using established criteria children were classified a priori by an independent investigator as having constipation (C) or non-retentive soiling (NRS). Results: 165 patients were studied (125 C, and 35 NRS). There were significant differences (P < 0.05) when comparing those with C and those with NRS: CT: 51 ± 18 vs 40 ± 21 hrs; Barr: 14 ± 5 vs 11 ± 4; Leech: 10 ± 2 vs 8 ± 2; FL: 2 ± 0.5 vs 1.7 ± 0.4. The table shows the distribution of normal or abnormal scores. Even though Barr and Leech scores were more often abnormal in those with C, >20% had normal scores, and >50% of NRS had abnormal scores. CT discriminated better between C and NRS. There was a significant correlation (P < 0.05) between CT and Barr (0.45), Leech (0.41) and FL scores (0.36), and between Barr and Leech scores (r = 0.94). There was good intraobserver correlation between Barr, Leech and FL scores. There was poor interobserver reproducibility of the Barr (kappa 0.3), Leech (kappa 0.25) and FL scores (kappa 0.3).TableConclusions: There are significant differences in the overall scores between C and NRS. The discriminative value to detect C is low for all scores. There is poor interobserver reproducibility of the Barr, Leech and FL scores. These findings confirm the limited value of the plain abdominal X-ray in the evaluation of children with constipation.
ABSTRACT Objectives: Gender equality in the workplace has not been described in pediatric gastroenterology. Methods: An electronic survey that explored perceptions of career parity, work–life balance, and workplace harassment was sent to all members of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Reponses were anonymous. Results: Of the 303 respondents (21%), there was an even distribution across geographic region, age, and gender (54% men). Gender affected perception of salary and promotion; 46% of men but only 9% of women feel that “women earn the same as men” ( P < 0.001). Similarly, 48% of men but only 12% of women feel that “women rise at the same rate as men” ( P < 0.001). Both genders of academic practice respondents, compared with other practice models, perceived men were promoted more quickly than women ( P = 0.008). Women had higher dissatisfaction with mentoring than men (29% vs 13%, P = 0.03). Significantly more men than women reported spouses with “flexible jobs” (35% vs 14%, P < 0.001). Having a spouse with “flexible job” or having children (preschool or school age), however, did not affect satisfaction with work–life balance for either gender. Overall, women are more likely to be dissatisfied with work–life balance than men ( P = 0.046). Conclusions: Satisfaction with work–life balance is lower among women versus men pediatric gastroenterologists, but does not correlate with flexibility of spouse's job or caring for young children. Gender‐divergent perception of promotion, parity of compensation, and mentoring requires further investigation.
Adolescents with chronic illness need to develop skills to independently manage their own health. Knowledge of medication is an early step in this process. We explored which factors affect acquisition of medication knowledge in adolescents with inflammatory bowel disease (IBD).Consecutive patients with IBD older than 10 years received a confidential survey at an outpatient visit including questions regarding medication name, dose, and adverse effects. Results were compared with the medical record. Demographic characteristics obtained included age, sex, disease duration, and type of IBD.Completed surveys were returned by 294 patients (65% of those approached). Overall, 95% of patients could name their medication and 54% could identify their correct dose. Of 95 patients receiving biologics, 88% could identify the medicine and 50% could report either dose or timing. Of 139 patients on immunomodulator therapy, 94% could name medicine and 68% reported correct dose. Sex, type, or duration of disease did not affect name or dose knowledge. Generally, older patients did not demonstrate better medication or dosage knowledge than younger patients, although there was a significant trend toward improved knowledge of side effects for older patients. However, <32% of all of the patients could report a single major medication side effect.Medication knowledge is an early stage of self-management, yet many adolescents cannot report the dose of IBD medications, nor know the side effects of immunosuppression. This finding persists into late adolescence, which has ramifications for patients as they separate from parents for college or work.
The cyclical nature of chronic illness requires that children with inflammatory bowel disease be transitioned to the adult medical system with as much continuity of care as possible. Transition from pediatric to adult medical care continues to present significant barriers. The philosophy of transition centers on a process, with the actual transfer to adult care as a point along this clinical pathway. Concrete steps can be taken to help patients prepare for new responsibilities. The aim of this review is to propose a clinical and developmental timeline for both patients and their medical team, including specific responsibilities for both, so that the partnership can best promote a successful transition.
Objective: Patients gradually assume responsibility for self-management. This study sought to determine whether adolescents with inflammatory bowel disease (IBD) have developed key skills of self-management prior to the age at which many transfer to adult care. Patients and Methods: Adolescents aged 16 to 18 years old in the Children’s Hospital Boston IBD database (94 total) received a mailed survey assessing knowledge and confidence of their own health information and behaviors. Results: Respondents (43%) could name medication and dose with confidence but had very poor knowledge of important side effects. Most patients deferred responsibility mostly or completely to parents for scheduling appointments (85%), requesting refills (75%), or contacting provider between visits (74%). Conclusions: Older adolescents with IBD have good recall of medications but not of side effects. Parents remain responsible for the majority of tasks related to clinic visits and the acquisition of medications.
