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A Clinical Lens on Pediatric Engineering

Pioneering Science and Technology for Cutting-Edge Patient Care

herausgegeben von: Jamie Leigh Wells

Verlag: Springer Nature Switzerland

Enthalten in: Springer Professional "Wirtschaft+Technik" , Springer Professional "Technik"

Inhaltsverzeichnis

Über dieses Buch

A Clinical Lens on Pediatric Engineering: Pionering Science and Technology for Cutting-Edge Patient Care untersucht die Tiefe und Breite der neu angewandten Wissenschaft der Pädiatrie und ihrer beginnenden Ära. Dieser tiefe Einblick in medizinische Digital-to-Device-Innovationen stellt die Ursprünge der pädiatrischen Medizin und Technik in den Kontext und integriert wissenschaftliche Strenge mit klinischer Perspektive, wobei Fallbeispiele diagnostischer und therapeutischer Durchbrüche, warnende Geschichten und Lektionen in der Übersetzung berücksichtigt werden. Das Buch beginnt mit der Erklärung der einzigartigen Überlegungen des sich entwickelnden Kindes und der Bedeutung der Einbeziehung nuancierter Faktoren des Endverbrauchers und des Menschen früh und häufig in den Prozess der Suche nach biomedizinischen Lösungen. Es bietet einen Überblick über die vielfältigen und dynamischen biopsychosozialen Merkmale dieser Population im Vergleich zu Erwachsenen, kontrastierende Organsysteme, kognitive Reifung, Bioethik, Wachstum und Drogenstoffwechsel. Ein renommiertes Team von Mitarbeitern liefert einen umfassenden Entwurf für die Umsetzung einer Idee bis hin zur klinischen Umsetzung, der die ständig wachsenden Einflüsse und Feinheiten der Entdeckung aufzeigt. Das Buch deckt ein breites Spektrum an Themen ab, darunter fetale Intervention, Transplantation, regenerative Medizin, Sucht, Augenheilkunde, Chirurgie (z.B. minimal invasive, orthopädische), Krebs, Nanotechnologie, bildgebende Verfahren in der Radiologie, Gentherapie, künstliche Intelligenz (KI), maschinelles Lernen, Flüssigbiopsie, immersive Technologien (z.B. erweiterte und virtuelle Realität), Neurodiversität, seltene Krankheiten, Intensivmedizin, Robotik, Materialwissenschaft und Gewebetechnik. Die gestalterischen Herausforderungen, die speziell für Kinderkrankenhäuser und Gesundheitseinrichtungen gelten, werden diskutiert, wobei die erforderliche Flexibilität betont wird, um optimale Patientenergebnisse zu erzielen, aussagekräftige Daten zu sammeln und innovative Fortschritte voranzutreiben. Diese bahnbrechende Arbeit ruft die wichtigsten Akteure dazu auf, die Hindernisse im Zusammenhang mit Finanzierungspraktiken, klinischen Studien und anderen Hindernissen zu beseitigen, die die rechtzeitige und sichere Bereitstellung lebensverändernder und lebensrettender Ergebnisse behindern. Sie bietet Innovatoren im Bereich der Kindergesundheit die wesentlichen Werkzeuge, um diese Lücken zu schließen und den Wandel in der sich rasch entwickelnden Landschaft der pädiatrischen Versorgung voranzutreiben.

Mit KI übersetzt

Über dieses Buch

A Clinical Lens on Pediatric Engineering: Pioneering Science and Technology for Cutting-Edge Patient Care explores the depth and breadth of the newly applied science of pediatric engineering and its dawning era. Placing into context the origins of pediatric medicine and engineering, this deep dive into and beyond medical digital-to-device innovation integrates scientific rigor with clinical perspective, incorporating case examples of diagnostic and therapeutic breakthroughs, cautionary tales, and lessons in translation.

The book begins by explaining the unique considerations of the developing child and the importance of including nuanced end-user and human factors early and often in the process of seeking biomedical solutions. It provides an overview of this population's diverse and dynamic biopsychosocial characteristics compared to adults, contrasting organ systems, cognitive maturation, bioethics, growth, and drug metabolism. A distinguished team of contributors supplies a comprehensive blueprint for transforming an idea through to clinical implementation, featuring the ever-expanding influences and intricacies of discovery. The book covers a wide array of topics, including fetal intervention, transplantation, regenerative medicine, addiction, ophthalmology, surgery (e.g., minimally invasive, orthopedic), cancer, nanotechnology, radiology imaging modalities, gene therapy, artificial intelligence (AI), machine learning, liquid biopsy, immersive technologies (e.g., augmented and virtual reality), neurodiversity, rare disease, critical care, robotics, materials science and tissue engineering. The design challenges specific to children’s hospitals and healthcare facilities are discussed, highlighting the flexibility needed to achieve optimal patient outcomes, gather meaningful data, and drive innovative progress.

This landmark work calls on key stakeholders to address the obstacles related to funding practices, clinical trials, and other impediments that hinder the timely and safe delivery of life-altering and life-saving results. It provides child health innovators with the essential tools to bridge these gaps and drive transformation in the rapidly evolving landscape of pediatric care.

Inhaltsverzeichnis

Frontmatter

Know Thy Patient: Design and Adapt Accordingly

Frontmatter

A Brief History of Pediatrics and the Beginnings of Pediatric Engineering

Abstract

Pediatrics is a branch of medicine concerned with children’s physical, mental, and psychosocial health. We have recognized for centuries that children are not just “little adults” with respect to their unique developmental trajectories, disease conditions, and drug-/small molecule-based and device-based therapies. This introduction to the history of child health serves as the backdrop to this volume on pediatric engineering. The chapter starts with the historical evolution of clinical pediatrics and its inexorable subspecialization as the body of knowledge and therapeutic approaches grew. Next, we interweave several illustrative examples of why “children are not just little adults”: The special cases of the developing human being and newborn infant; the dawn of pediatric surgery; pharmacokinetics and pharmacodynamics in children; and allometry, the complex science of size and scaling. The need for tailored therapy in the pediatric population further illustrates how children are distinct from adults, including their medical treatments, surgical and procedural interventions, and devices; pediatric public health and social engineering; and gene therapy. Then, we touch on how early life events—in both health and disease—can cast ripples decades later: the developmental origins of adult disease. Finally, despite the many advances specific to children’s health, disease, and treatment, we also take some lessons from occasions when pediatrics has failed children. Much work remains to be done to optimize the long-term health and well-being of all individuals within the pediatric-age population, but we are now at an exciting point in the history of pediatrics to start seeing truly tailored and individually engineered therapies for children of all ages, starting even before birth.

Colin K. L. Phoon

Pediatric Pharmacotherapy: Beyond Scaling—Understanding Developmental Dynamics and Therapeutic Adaptations

Abstract

This chapter discusses the complexities of pediatric pharmacotherapy, emphasizing the need to recognize children as distinct from adults in medical treatment. There is a critical need to approach medication use in children with tailored strategies that take into consideration developmental pharmacokinetic and pharmacodynamic variances. Historical lack of pediatric information in research and drug labeling has led to inadequate extrapolation of adult data and off-label use of medications, which can put children at risk. The discussion further extends into drug design challenges for patients, caregivers, and healthcare professionals and emphasizes the need for pediatric-specific formulations and prioritizing safety in children. Promising advancements in research integrating technology, data and artificial intelligence is on the horizon. However, caution and proactive efforts are essential to ensure the inclusion of children in these innovations. This chapter provides a comprehensive overview of the challenges and advancements in pediatric medicine, advocating for continued efforts to address their unique needs.

Joyce P. Lee

Beyond the Clinical: How a Holistic Approach to Design Builds a Strong Foundation for Modern Pediatric Healthcare

Abstract

The transformation in pediatric care settings has been driven by a combination of societal changes, medical advances, emphasis on patient- and family-centered care, and a growing understanding of children’s developmental needs. Pediatric facilities have transitioned from environments that mix children with adult patients to those that are engaging and secure, supporting a child's developmental journey from infancy through adolescence. This has included the integration of design elements that are comforting and familiar, yet stimulating and age-agnostic, such as interactive and multisensory experiences to reduce stress during medical procedures.

Moreover, the evolution of design philosophies has embraced evidence-based and human-centered methodologies, focusing on creating spaces that support psychological, social, and physiological health. In pediatric healthcare settings, designs must cater to the distinct physiological, cognitive, and emotional needs of children compared to adults, while also accommodating the broad support system that surrounds pediatric patients. The iterative engagement of pediatrics, their families, staff, and other key stakeholders in the design process ensures that these environments are not only functional but also resonate with patients’ and families’ experiences and expectations. This holistic approach to pediatric healthcare design aims to foster environments that are not only healing but also nurturing, thereby enhancing the overall well-being and development of children in healthcare settings.

The translation of diverse inputs—such as organizational culture, budget, patient demographics, and community characteristics—into a functional and holistic building design encompasses various phases: Programming, which defines the project’s vision and requirements; Schematic Design, focusing on site configuration and initial layouts; Design Development, where technical, functional, and aesthetic elements are integrated; and Construction Documentation, which finalizes the building instructions. Throughout these phases, designers create integrated “design layers,” a concept that synergizes multiple design aspects around operations and process considerations. These layers address numerous operational and physical challenges, offering solutions that prioritize patient and staff needs while aligning with organizational protocols. Site-specific factors, exterior design elements, department sizes, room sizes, adjacencies, interiors, and furniture and equipment configurations must be meticulously planned to enhance functionality and safety. By iteratively developing these layers in coordination with organizational processes, the design approach not only meets the immediate needs of healthcare delivery but also adaptably responds to the evolving demands of healthcare environments, care delivery models, and supporting technology. Descriptive and visual examples of these layers are included to demonstrate how design solutions can foster a patient-centered, family-friendly environment that supports both clinical efficiency and comfort.

Despite the evolving landscape of healthcare demands, the overarching trend towards patient- and family-centered care remains paramount, driving the continual evolution of pediatric healthcare design to prioritize user experience and well-being.

Leslie Kipps, Adrienne Erdman

Bioethics and the Life of the Child

Abstract

Ethics has long been an important part of medical practice, and rightly so. Ethics lies at the heart of providing compassionate and quality care, as the concepts of ethics, compassion, and quality are virtually inseparable from a healthcare standpoint. When we, as healthcare professionals, engage with patients and their families, a culture of ethics is essential to ensuring that the best diagnosis is given and the strongest course of action is chosen. This is of critical importance with respect to the pediatric population since interventions—or the withholding of them—can have a reverberating impact well into the future. However, the development of mindfulness toward ethics and how it can be operationalized to create a compassionate healthcare environment can be more difficult than one might expect without an understanding of the fundamentals of ethics and how they have been highlighted in profound ethical cases that have existed in medicine. The purpose of this chapter is to expose readers to prominent healthcare challenges, as well as some of the ethical conundrums that have grown out of these healthcare challenges—touching upon the realm of scientific and technological advancement.

By the completion of this chapter, readers will be able to discuss the foundational principles of medical ethics and the frameworks for ethical decision-making; articulate how infants, toddlers, children, and adolescents are uniquely affected by medical ethics and how this changes throughout development; apply the foundational principles of medical ethics to healthcare encounters involving children and adolescents; and relate medical ethics to the lives of children and adolescents.

Brooke M. Ellison, Jamie Leigh Wells

Facilitating Progress from Bench to Bedside: Wins, Cautionary Tales, and Lessons in Translation

Frontmatter

Advancing Pediatric Healthcare: A Guide to Medical Device Innovation from Conceptualization to Clinical Use

Abstract

This chapter presents an approach to pediatric medical device innovation in the United States and highlights the steps required to go from a great idea to a tangible solution that directly impacts pediatric patients: conceptualization, prototyping, preclinical and clinical testing, regulatory approval, and implementation. We explore the modern Biodesign approach to needs finding and pediatric medical device conceptualization with a focus on the unique challenges of designing such devices. We also discuss the complexities and ethical concerns involved in preclinical and clinical testing. We then examine the regulatory landscape of pediatric medical devices. Finally, we discuss how these devices can be implemented in clinical practice and the importance of fostering public-private partnerships to drive ongoing pediatric healthcare innovation. By the end of the chapter, innovators should have a comprehensive understanding of how to take an idea from conceptualization to clinical use.

R. Brandon Hunter, Jhalak N. Mehta, Christine Luk, Chester J. Koh

The Rapidly Evolving Regenerative Medicine Ecosystem: Implications for Infants and Children

Abstract

Significant advancements in regenerative medicine have the potential to transform pediatric healthcare. Improvements in diagnostics (e.g., genome sequencing) as well as the development of novel therapeutics (e.g., cell/gene therapies, ex-vivo/in-vivo gene editing) are creating a renaissance in potentially curative treatments. This provides hope for patients and families with limited therapeutic interventions, with more than 34 regenerative medicines already approved by the US Food and Drug Administration for human use. These treatments have targeted conditions like inherited retinal disorders, spinal muscular atrophy, and sickle cell disease. Developing gene therapy and gene editing therapeutics for infants involves unique considerations to ensure safety and efficacy in this vulnerable population. Adeno-associated viruses (AAVs) serve as a preferred vector for gene delivery due to their ability to infect humans without causing significant disease. In addition, clustered, regularly interspaced short palindromic repeats (CRISPR) technology offers unprecedented precision in gene editing. However, there is a critical need to establish improved safety profiles, with a focus on immunogenicity, genotoxicity, and the development of new delivery systems. The International Neonatal Consortium (INC) is working to streamline regulatory paths for neonatal therapies, highlighting the need for collaborative efforts from researchers, clinicians, regulators, and families to overcome these challenges. Ethical, financial, and logistical considerations are all equally important, particularly in ensuring equitable access to these potentially transformative treatments. Moreover, the importance of long-term follow-up to monitor safety and efficacy is emphasized, along with the need for careful patient selection and study design. This rapidly evolving field demands ongoing innovation, careful ethical consideration, and ecosystem-wide collaboration to realize its full promise for the future of child health.

Thomas F. Miller, Kanwaljit Singh, Nikki Montgomery, Carole Kenner, Wakako Minamoto Eklund, Jonathan M. Davis

Pediatric Engineering in Clinical Context: Digital to Device Innovation—Past, Present, and Future

Frontmatter

Emergence of Liquid Biopsies in Pediatric Eye Cancers

Abstract

Liquid biopsies have revolutionized the field of oncology and are especially appealing as they provide a minimally invasive method of obtaining tumor information. This enables serial sampling of tumor information, allowing real-time molecular profiling. Liquid biopsy companion diagnostic tests have been approved by the U.S. Food and Drug Administration (FDA) for several adult cancers, with applications that include directing targeted therapies. In pediatric cancers, there has been a lag in liquid biopsy clinical applications, with most studies being performed retrospectively and not yet making a widespread impact on patient care. However, studies demonstrate that this technology has substantial potential in redefining and, in some cancers, introducing personalized medicine approaches to pediatric clinical oncology. This chapter will discuss the rise of two promising liquid biopsies, aqueous humor and blood, for the most common pediatric ocular cancer, retinoblastoma.

Shreya Sirivolu, Liya Xu, Jesse L. Berry

Care Innovation in Pediatric Radiology

Abstract

Pediatric Radiology has advanced significantly as a subspecialty of radiology. This chapter serves to review the origins of pediatric radiology, the modalities used to image and diagnose disease in children, and the evolution of these modalities through the years. The author also examines the unique psychosocial issues that encompass working with children and the care innovations that have allowed pediatric radiologists to interact with and better serve their patients and improve the quality of care. Finally, newer state-of-the-art imaging techniques are discussed while the current landscape and potential future impact of artificial intelligence (AI) on the field of pediatric radiology is explored.

Steven L. Blumer

Advancements in Pediatric Liver Transplantation: Innovations and Future Directions

Abstract

Pediatric liver transplantation is a well-established and lifesaving intervention for children with end-stage liver disease, reflecting the collaborative efforts of medical professionals and the relentless pursuit of therapeutic advancements. Over the last several decades, graft and patient survival have shown marked improvements due to enhancements in medical management, surgical techniques, immunosuppression, and organ availability. The utilization of split-liver grafts and living-related donors has facilitated an expansion in the donor pool and allowed for decreased wait times to transplant. The outlook for pediatric liver transplantation shows ongoing advancements aimed at minimizing prolonged immunosuppression and embracing precision medicine. By integrating genetic and molecular profiling, there exists the potential for enhancing donor-recipient compatibility and tailoring treatment plans to individual needs. Future developments will continue to focus on long-term outcomes with prevention of immunosuppression-related complications, transition of care, and health-related quality of life.

Jennifer Vittorio, Adam Griesemer

Beyond User-Centered Design: Designing Digital Health Technologies for Substance Use Prevention and Treatment in Children and Youth

Abstract

Over the past two decades, multiple digital health interventions have emerged to address substance use prevention and treatment among youth. Over 90% of adults with a substance use disorder report that they started using alcohol and drugs before age 18 (National Center on Addiction and Substance Abuse at Columbia University. https://eric.ed.gov/?id=ED521379). Youth substance use is associated with numerous adverse health outcomes, including increased risk of future addiction and mental health disorders, injury, overdose, and death. Few digital health interventions for substance use prevention and treatment among youth leverage user-centered design approaches or user experience evaluations. This chapter proposes a Child-Centered Design Framework (CCD) for digital health interventions that focus on substance use prevention and treatment in children and youth. The CCD Framework includes five dimensions to help guide the design and development of digital interventions: (1) Social-Ecology, (2) Child Development, (3) Theories and Frameworks, (4) Interaction Design Methods, Tools, and Techniques for Children, and (5) Evaluation. This chapter concludes with a call for future research to use the CCD Framework as a guide when planning the design, development, and evaluation process of digital health interventions for children and youth.

Kanu Priya Singh, Deepa R. Camenga, Kammarauche Aneni, Kimberly Hieftje

Technology and Innovation in Pediatric Surgery: The Past, The Cutting Edge, and Future Possibilities

Abstract

The advancement of technology in surgical science permitted the development of minimally invasive surgery (MIS), which allows patients to avoid the negative aspects of traditional “open” surgery. Surgeons and engineers worked in tandem to develop smaller and improved MIS instruments, leading to its application in children years after its introduction in adult surgery. While many advancements have been made, there remain limitations to pediatric MIS due to factors such as smaller operative fields and physiologic constraints. In addition to the creation of an MIS platform, other innovations aid with pain control after open surgery, planning operations using 3D printing, performing fetal surgery to prevent problems before they occur, and even methods to avoid surgery altogether. The unmet clinical needs in children and infants have fostered the development of new technologies and innovations which will allow an endless stream of possibilities to offer our pediatric patients.

Bianca Fischer, Nadeen Alturki, Keith Kuenzler

Pediatric Engineering: Pediatric Orthopedics

Abstract

Though orthopedic surgery started out as a field dedicated to correcting deformities in children, innovation and development of medical devices in the subspecialty of pediatric orthopedics has lagged behind the specialties that primarily treat adult conditions. There has, however, been a shift in the twenty-first century, toward dedicated pediatric orthopedic implants rather than repurposing those used in adults. Whether it is in fracture care, spine or lower extremity deformity correction, or reconstruction following tumor resection, there is a strong need to optimize the surgical and non-surgical care of this patient population. Decreased financial and regulatory barriers will certainly help this process; however, all stakeholders should be involved in order to have the best outcomes and the greatest chance of success.

Andrew Chou, Karim Masrouha

Interface of Engineering with Autism and Neurodiversity

Abstract

Many children are diagnosed with neurodiverse conditions like dyslexia, attention-deficit/hyperactivity disorder (ADHD) and autism. Biomedical engineering intersects with a number of dimensions of neurodiversity including research, diagnosis, and intervention. This chapter will first explore these conditions and then look at the impact of engineering on each of them. Autism will be a major focus, given its increasing numbers and the variety of ways in which engineering products can benefit this population.

Throughout this chapter, several specific points will be emphasized. For one, engineering projects designed for select populations often benefit everyone. Moreover, biomedical research has played a role in identifying these conditions on a physical level, elucidating their nature and decreasing misinterpretations of unexpected manifestations of behavior and performance. For example, brain scans have illuminated brain-based differences in individuals with dyslexia, which helps explain students who are smart, yet not learning as expected. Further, advances in engineering can modify the environment, with the understanding that sometimes the mismatch between the surroundings and the individual is the primary impediment to success.

Wendy J. Ross

Backmatter

Titel: A Clinical Lens on Pediatric Engineering
herausgegeben von: Jamie Leigh Wells
Verlag: Springer Nature Switzerland
Electronic ISBN: 978-3-031-84655-7
Print ISBN: 978-3-031-84654-0
DOI: https://doi.org/10.1007/978-3-031-84655-7