Pediatric extracorporeal membrane oxygenation is associated with significant morbidity and mortality. We sought to summarize literature on communication and decision-making, end-of-life care, and ethical issues to identify recommended approaches and highlight knowledge gaps.

Objective: Decision-making around tracheostomy placement and chronic respiratory support in children is complicated. Families often seek support and advice from outside the medical care team, including from social media. We undertook this study to characterize the content and nature of online resources created and managed primarily by caregivers of children living with tracheostomy and chronic mechanical ventilation.Design/Setting: We used a "grey literature" search methodology to identify internet resources created by caregivers of children with tracheostomy. We included only publicly available, nonindustry associated, English language, North American websites updated at least once in 2019. We then applied inductive content analysis to establish central themes, patterns and associations.Measurements/Main Results: We identified six blogs/forums that met our search criteria. We identified four main themes: (1) Uncertainty, (2) Lived experiencewants, needs, and emotions, (3) Seeking context and meaning, and (4) Advice/information sharing/support. Two patterns of coping were identified on the basis of the relationships between codes. The "Acceptance pathway" is associated with a sense of self-actualization, mastery, satisfaction, return to normalcy, and ultimately acceptance. The "Resignation pathway" is associated with a sense of lack of control, frustration, burnout and stress, persistent lack of normalcy, and resignation to the tracheostomy as a negative but necessary outcome. Conclusion:Caregivers often come to see themselves as experts in the care of children with tracheostomy, though many still express ambivalence about their knowledge and skills.

Youth bullying is a global public health problem; Internet addiction is on the rise globally among youths. Because the linkage between these behaviors has not been clearly explicated, this integrative review evaluated the relevant empirical evidence. A search of five electronic databases identified 2,761 original citations published between January 2000 and May 2019. After further abstract screening and detailed evaluation of 262 full-text articles, the final sample consisted of 14 prospective descriptive studies representing 10 countries. Review results clearly established that the relationship between bullying and Internet addiction is firmly supported; less is known as to the contribution of gender, age, and other demographic variables, their impact on health outcomes, problematic behaviors, and the role of parental mediation. Inconsistent definitions and instrumentation and lack of sophisticated study designs limited the synthesis of findings. Future research is needed to explicate these relationships, so data-driven interventions can be developed.