You have accessJournal of UrologyPediatrics III (MP50)1 May 2024MP50-18 NOVEL USE OF AN ENURESIS ALARM TO GUIDE TIMING OF BLADDER EMPTYING ASSESSMENT IN COMPLEX NON-VERBAL CHILDREN Peter Y. Cai, Andrea Balthazar, Regina L. Tham, Badar Omar, Sangeeta Mauskar, Walter Wickremasinghe, Bartley G. Cilento, and Caleb P. Nelson Peter Y. CaiPeter Y. Cai , Andrea BalthazarAndrea Balthazar , Regina L. ThamRegina L. Tham , Badar OmarBadar Omar , Sangeeta MauskarSangeeta Mauskar , Walter WickremasingheWalter Wickremasinghe , Bartley G. CilentoBartley G. Cilento , and Caleb P. NelsonCaleb P. Nelson View All Author Informationhttps://doi.org/10.1097/01.JU.0001008684.57262.97.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder emptying is often impaired in non-verbal children with medical complexity, but assessment is challenging due to the lack of indication that voiding has occurred. We sought to test the feasibility and efficacy of an enuresis alarm to guide timing of post-void residual (PVR) measurement in these patients. METHODS: We prospectively enrolled 15 complex patients (<21 years old, nonverbal, diaper-voiding) hospitalized July-September 2023. Exclusion criteria were urinary tract infection or indwelling catheter. Protocol included a 4-hour period with alarm in place (PVR assessment after alarm trigger), and a 4-hour period of routine care (PVR assessment based on nurse observation of wet diaper). PVR was measured with an ultrasound bladder scanner. The primary endpoint was PVR volume with or without alarm. Secondary endpoint was number of detected voids. RESULTS: Median age was 10 years (range 0.8 to 16) and median weight was 20.7 kg (range 6.8 to 49.6). The most common diagnoses were cerebral palsy (n=7), spastic quadriplegia (n=5), and epilepsy (n=7). Four patients were not included in data analysis due to not having at least one void in both the alarm and routine study periods for comparison. After excluding voids less than 10% of estimated bladder capacity (6/50), and alarms triggered by stool, we found on linear regression analysis that use of alarm was associated with a mean decrease of 21.09 mL (95% CI -40.60 to -1.58, p=0.035) in PVR volume, when adjusting for patient weight (Figure 1). Every 1 kg increase in weight was also associated with a mean increase of 1.36 mL (95% CI 0.53 to 2.19, p=0.002) in PVR volumes. Median number of detected voids were also significantly different in the alarm versus routine care periods (3 vs. 1, p=0.0312). No adverse events occurred during the study sessions. CONCLUSIONS: An enuresis alarm facilitated detecting significantly more voids and smaller PVR volume in a population of complex non-verbal, diaper-voiding patients. Such alarms may prove useful to more accurately measure PVR in this challenging population. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e839 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Peter Y. Cai More articles by this author Andrea Balthazar More articles by this author Regina L. Tham More articles by this author Badar Omar More articles by this author Sangeeta Mauskar More articles by this author Walter Wickremasinghe More articles by this author Bartley G. Cilento More articles by this author Caleb P. Nelson More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND AND OBJECTIVES:Hospitalized children with medical complexity (CMC) are at high risk of medical errors. Their families are an underutilized source of hospital safety data. We evaluated safety concerns from families of hospitalized CMC and patient/parent characteristics associated with family safety concerns.METHODS:We conducted a 12-month prospective cohort study of English- and Spanish-speaking parents/staff of hospitalized CMC on 5 units caring for complex care patients at a tertiary care children's hospital. Parents completed safety and experience surveys predischarge. Staff completed surveys during meetings and shifts. Mixed-effects logistic regression with random intercepts controlling for clustering and other patient/parent factors evaluated associations between family safety concerns and patient/parent characteristics.RESULTS:A total of 155 parents and 214 staff completed surveys (>89% response rates). 43% (n = 66) had ≥1 hospital safety concerns, totaling 115 concerns (1-6 concerns each). On physician review, 69% of concerns were medical errors and 22% nonsafety-related quality issues. Most parents (68%) reported concerns to staff, particularly bedside nurses. Only 32% of parents recalled being told how to report safety concerns. Higher education (adjusted odds ratio 2.94, 95% confidence interval [1.21-7.14], P = .02) and longer length of stay (3.08 [1.29-7.38], P = .01) were associated with family safety concerns.CONCLUSIONS:Although parents of CMC were infrequently advised about how to report safety concerns, they frequently identified medical errors during hospitalization. Hospitals should provide clear mechanisms for families, particularly of CMC and those from disadvantaged backgrounds, to share safety concerns. Actively engaging patients/families in reporting will allow hospitals to develop a more comprehensive, patient-centered view of safety.

Discussion | In this study, which is to our knowledge the first to longitudinally examine sexual identity and sexual contact in a nationally representative sample of high school students, an increase was noted for nonheterosexual identity but not same-sex sexual contact.However, it is unclear to what extent this increase reflects a change in the true prevalence of nonheterosexual sexual identities or whether the observed increase was in part because of increased comfort with selfdisclosure.In terms of additional limitations, the YRBS questionnaire never explicitly defined the term sexual contact 4 and failed to adequately distinguish between same-sex and samegender sexual contact. 5Moreover, some participants may have responded to the question assessing sex with their gender identity, leading to the incorrect classification of same-sex sexual contact.Furthermore, some youths in sexual minority groups may have felt their identity was not represented by the available responses to the question regarding sexual identity.Additionally, adolescents may have underreported nonheterosexual sexual identities and same-sex sexual contact because of persistent stigma associated with sensitive topics such as sexual identity. 6lthough the YRBS measures are imperfect, the apparent increase in nonheterosexual identity among youth in the US calls for greater vigilance among health care professionals regarding the heightened risks faced by these youths, such as bullying and mental health challenges.

Background: Pediatric Hospital Medicine (PHM) fellowship programs must train leaders to address local and systemic health care challenges. It is unknown how leadership development education is currently incorporated into PHM fellowship and which topics should be included in future training. Objective: To identify fellowship directors’ perspectives on which leadership development topics are currently taught to PHM fellows and which topics should be required education during PHM fellowship training. Methods: …