bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduced cervical sampling of hysterectomy specimens with negative margins on conization: An opportunity to improve resource utilization
Authors: Al-Nattah Sanaa , Martin Annona , Normington Lacy , Weisman Paul S , Wallace Sumer , McGregor Stephanie M
Published: October 2024

Objectives

The current recommendation for hysterectomy specimens performed for cervical cancer following conization is that the entire cervix be submitted for histologic examination. Given the high cost of medical procedures and concerns regarding difficulties with laboratory staffing, we sought to evaluate the potential for selective histologic examination in this setting.

Methods

Post-conization hysterectomy cases were reviewed for the presence of residual disease in relation to the findings of the prior conization, with consideration of margin status. Residual disease was then assessed for clinical significance. The number of submitted blocks was recorded and the associated costs were estimated.

Results

Among 32 cases with invasive carcinoma, only cases with margins positive for invasive carcinoma on the conization specimen had residual invasion in the hysterectomy (n = 7), and there were no upgrades due to subtle microscopic disease; 1 case had a change in pathologic stage from pT1b1 to pT2b due to parametrial involvement in the setting of a grossly apparent lesion. Among 20 cases performed following a diagnosis of dysplasia, none were upgraded to invasive carcinoma. Based on protocol-based submission of the entire cervix, 16 blocks of cervix were submitted on average (range, 4-41).

Conclusions

We estimate that representative sections from each cervical quadrant would save approximately 2 work hours for laboratory staff per case and up to 6 hours for larger cases, reducing costs for the laboratory accordingly. Selective cervical sampling in the setting of negative margins on conization provides an opportunity for improved resource utilization without compromising patient care; as this is a small study, confirmation of these findings in a larger number of cases may be warranted. Additional studies are necessary to determine what other contexts in surgical pathology could benefit from a similar reductive approach.
Simplicity within biological complexity
Authors: Pržulj Nataša , Malod-Dognin Noël
Published: October 2024

Motivation

Heterogeneous, interconnected, systems-level, molecular (multi-omic) data have become increasingly available and key in precision medicine. We need to utilize them to better stratify patients into risk groups, discover new biomarkers and targets, repurpose known and discover new drugs to personalize medical treatment. Existing methodologies are limited and a paradigm shift is needed to achieve quantitative and qualitative breakthroughs.

Results

In this perspective paper, we survey the literature and argue for the development of a comprehensive, general framework for embedding of multi-scale molecular network data that would enable their explainable exploitation in precision medicine in linear time. Network embedding methods (also called graph representation learning) map nodes to points in low-dimensional space, so that proximity in the learned space reflects the network’s topology–function relationships. They have recently achieved unprecedented performance on hard problems of utilizing few omic data in various biomedical applications. However, research thus far has been limited to special variants of the problems and data, with the performance depending on the underlying topology–function network biology hypotheses, the biomedical applications, and evaluation metrics. The availability of multi-omic data, modern graph embedding paradigms and compute power call for a creation and training of efficient, explainable and controllable models, having no potentially dangerous, unexpected behaviour, that make a qualitative breakthrough. We propose to develop a general, comprehensive embedding framework for multi-omic network data, from models to efficient and scalable software implementation, and to apply it to biomedical informatics, focusing on precision medicine and personalized drug discovery. It will lead to a paradigm shift in the computational and biomedical understanding of data and diseases that will open up ways to solve some of the major bottlenecks in precision medicine and other domains.
Leveraging information from secondary endpoints to enhance dynamic borrowing across subpopulations
Authors: Wolf Jack M , Vock David M , Luo Xianghua , Hatsukami Dorothy K , McClernon F Joseph , Koopmeiners Joseph S
Published: October 2024

Randomized trials seek efficient treatment effect estimation within target populations, yet scientific interest often also centers on subpopulations. Although there are typically too few subjects within each subpopulation to efficiently estimate these subpopulation treatment effects, one can gain precision by borrowing strength across subpopulations, as is the case in a basket trial. While dynamic borrowing has been proposed as an efficient approach to estimating subpopulation treatment effects on primary endpoints, additional efficiency could be gained by leveraging the information found in secondary endpoints. We propose a multisource exchangeability model (MEM) that incorporates secondary endpoints to more efficiently assess subpopulation exchangeability. Across simulation studies, our proposed model almost uniformly reduces the mean squared error when compared to the standard MEM that only considers data from the primary endpoint by gaining efficiency when subpopulations respond similarly to the treatment and reducing the magnitude of bias when the subpopulations are heterogeneous. We illustrate our model’s feasibility using data from a recently completed trial of very low nicotine content cigarettes to estimate the effect on abstinence from smoking within three priority subpopulations. Our proposed model led to increases in the effective sample size two to four times greater than under the standard MEM.
Single-cell sequencing technology in skin wound healing
Authors: Cheng Xu Cheng , Tong Wang Zi , Rui Wang , Feng Zhao , Shuai Hou , Zhe Wang
Published: October 2024

Skin wound healing is a complicated biological process that mainly occurs in response to injury, burns, or diabetic ulcers. It can also be triggered by other conditions such as dermatitis and melanoma-induced skin cancer. Delayed healing or non-healing after skin injury presents an important clinical issue; therefore, further explorations into the occurrence and development of wound healing at the cellular and molecular levels are necessary. Single-cell sequencing (SCS) is used to sequence and analyze the genetic messages of a single cell. Furthermore, SCS can accurately detect cell expression and gene sequences. The use of SCS technology has resulted in the emergence of new concepts pertaining to wound healing, making it an important tool for studying the relevant mechanisms and developing treatment strategies. This article discusses the application value of SCS technology, the effects of the latest research on skin wound healing, and the value of SCS technology in clinical applications. Using SCS to determine potential biomarkers for wound repair will serve to accelerate wound healing, reduce scar formation, optimize drug delivery, and facilitate personalized treatments.
Photoredox-catalyzed S-alkenylation of benzenethiols with alkenyl halides
Authors: Nishino Sodai , Kurahashi Takuya
Published: October 2024

Vinyl sulfides are important structural motifs that allow various organic compounds. Herein, we report the facile synthesis of vinyl sulfides through the photoredox-catalyzed coupling reaction of alkenyl halides with benzenethiols. The reaction can proceed without the use of transition metal catalysts.
Signs of economic development in the Kingdom of Naples under the Aragonese Crown: the Coppola Company
Authors: Petracca Luciana
Published: October 2024

The article examines the role played by Loise and Francesco Coppola’s company under the Aragonese Crown, so as to outline the socio-economic situation of Southern Italy at that time and examine the impact of foreign merchant-banking companies on the development of local entrepreneurship. In the second half of the fifteenth century, Florentine bankers Filippo and Lorenzo Strozzi established a bank in Naples. Using two surviving general journals, dating back to 1473 and 1476, their lending business can be analysed. As the bookkeeper of the Strozzi Bank used to record any transaction using double-entry bookkeeping, such journals help to identify the types of clients the Strozzi Bank dealt with and the reasons for individual transactions. The article outlines the crucial role played by the Coppola family in the development of the southern economy in the fifteenth century, showing how their company was part of international commercial networks that included the wealthiest and most powerful merchant-banking businesses of the time.
GLP-1 Receptor Agonists Confer No Increased Rates of IBD Exacerbation Among Patients With IBD
Authors: Levine Irving , Sekhri Shaina , Schreiber-Stainthorp William , Locke Brandon , Delau Olivia , Elhawary Mohamed , Pandit Krutika , Meng Xucong , Axelrad Jordan
Published: October 2024

Background

In patients with inflammatory bowel disease (IBD), multimorbidity with obesity and type 2 diabetes is common and increasing. Glucagon-like peptide 1 (GLP-1) receptor agonists are increasingly being prescribed for patients with IBD, yet their impact on patients with IBD is largely unknown. We aimed to assess the impact of GLP-1 receptor agonists on the course of IBD.

Methods

We identified all IBD patients prescribed GLP-1 receptor agonists at a large academic healthcare network between 2009 and 2023. We analyzed demographics and IBD characteristics in the year pre- and post–GLP-1 receptor agonist prescription and matched them to non-IBD controls. Our primary outcome was IBD exacerbation in the year following GLP-1 receptor agonist initiation, measured as a composite of IBD-related hospitalization, corticosteroid prescription, medication escalation or changes, or IBD-related surgery. Secondary outcomes included change in metabolic risk factors.

Results

Overall, 224 patients met inclusion criteria. At GLP-1 receptor agonist initiation, the median age was 54 years, 63% were female, 77% were White, and median BMI was 33.2 kg/m2. Compared to the 12-month period prior to GLP-1 receptor agonist initiation, in the 12 months post–GLP-1 receptor agonist initiation, there was no change in rates of IBD exacerbation, IBD-related hospitalization, steroids prescription, medication escalation or changes, or IBD-related surgery. There was a significant decrease in BMI in the year following GLP-1 receptor agonist initiation (median BMI 33.5 vs 31.6 kg/m2, P < .01), with rates of decrease comparable to non-IBD matched controls.

Conclusions

In patients with IBD, GLP-1 receptor agonists are effective for weight loss and associated with few episodes of disease exacerbation.
Reimagining Comparisons in International Relations through Reflexivity
Authors: Lai Daniela
Published: October 2024

The article argues that International Relations, and especially those approaches that are informed by the epistemological and methodological premises of reflexivity, would benefit from a more diversified range of comparative methodologies other than those deriving from the work of J.S. Mill and more recent developments within the neopositivist canon. While discussions of methodology in International Relations have become open to a diversity of approaches in recent years, scholars have often been less prone to formulate explicit methodological guidance, especially in the form of practical guidance for alternative comparative research designs. Building on but further developing existing work on reflexivity and methodology, the article thus aims to open up methodological possibilities for reflexive IR by delineating three comparative strategies: defamiliarizing discursive comparison, contrapuntal comparison, and vernacular comparison. Each of the strategies is explained with reference to its theoretical and methodological background in existing scholarship, two key stages for its practical application, as well as examples. The article concludes by highlighting the importance and urgency of methodological innovation in IR––especially when it comes to approaches inspired by reflexivity.
Rare but Relevant: Characterizing Self-Inflicted Burn Injuries in the United States
Authors: Manasyan Artur , Cannata Brigette , Malkoff Nicolas , Stanton Eloise W , Stoycos Sarah A , Yenikomshian Haig A , Gillenwater T Justin
Published: October 2024

Self-inflicted burns (SIBs) represent a distinct entity in burn care often associated with an underlying psychiatric etiology. In this review, we summarize the existing evidence on SIBs in North America to inform targeted prevention and interventions for patients afflicted with SIBs. The following databases were queried to identify relevant articles used for literature review: PubMed, Embase, and Scopus. The main outcome measures were burn characteristics and risk factors of SIBs in the American population. A total of 14,189 patients were included across 13 included studies. The percent of total body surface area burned ranged from less than 1% to 100%, with a mean of 29.6% ± 20.7%. Depressive disorders were the most reported overall; however, among mood disorders, bipolar disorder was also reported frequently, while anxiety was reported least. Motives for self-inflicting burn injury included premeditated self-injury as a coping mechanism, escape or response to delusions, impulsive self-injury, and most commonly, suicidal intention. The majority of the studies reported that preadmission drug and alcohol abuse were associated with the occurrence of SIBs. Other identified risk factors for SIB injury included female sex, younger age, unemployment, and unmarried status. From this, it is imperative that targeted interventions are developed to address the complex interplay of psychiatric disorders, drug use, and other demographic risk factors among the American population. It is crucial for initiatives to emphasize early identification of individuals at risk of self-harm, better access to mental health services, and stronger drug abuse programs to target SIB occurrence in the United States.
Phenology, voltinism, and brood development of Xylosandrus (Coleoptera: Curculionidae) ambrosia beetles in New York
Authors: Milbrath Lindsey R , Biazzo Jeromy
Published: October 2024

The ambrosia beetles Xylosandrus germanus (Blanford) and Xylosandrus crassiusculus (Motschulsky) are nonnative pests in orchards and nurseries in North America. They construct galleries in the sapwood of stressed woody hosts and culture a symbiotic fungus as food for their offspring. Preventing attacks is preferred but a better understanding of their biology may elucidate additional avenues for control. Recent phenological studies are lacking for X. germanus that is common in New York, and biological information on brood and gallery development is lacking for the less abundant X. crassiusculus. We conducted both outdoor rearing and laboratory studies to better understand the timing of key events in the maturation of their galleries, particularly associated with the symbiotic fungi. Two and a partial third summer generation were consistently observed over 2 yr for X. germanus; and thus, 3 flights of adult females (foundresses) occurred each summer from mid-April to late September. In both the field and laboratory, initial growth of the symbiotic fungus occurs within a few days of gallery initiation. The rapid development of the reproductive tract and oviposition by X. germanus appears to be stimulated by the presence of the fungus. Fungal, reproductive, and brood development are similar for the related X. crassiusculus in laboratory studies; the 2 species mainly appear to differ in size. The lag between beetle colonization and reproduction currently seems too brief to be exploited for management. Disruption of other stages in gallery development should also be explored to minimize the beetle damage if attacks cannot be prevented.
Detection of anti-leptospiral antibodies using recombinant ErpY-like lipoprotein based latex agglutination test for serodiagnosis of animal leptospirosis
Authors: Kumar Kirubakaran Vinod , Bokade Prajakta Prashant , Pal Archana , Deenadayalan Oviya , SowjanyaKumari Shashikumar , Bharath Venkatappa , Shome Bibek Ranjan , Balamurugan Vinayagamurthy
Published: October 2024

Precise and timely diagnosis is essential to prevent severe outcomes of leptospirosis in humans and animals. Existing diagnostic methods face challenges and limitations, underscoring the need for novel, field-applicable screening, and diagnostic tests/assays. This study evaluates the diagnostic utility of a recombinant ErpY-like lipoprotein (rErpY-LIC11966) in a latex agglutination test (LAT) for diagnosis of animal leptospirosis. The ErpY gene sequence from Leptospira interrogans serovar Pomona, excluding the signal peptide, was amplified, cloned into the pETite vector, and expressed in Escherichia coli. The expressed rErpY (∼16 kDa) was characterized by Sodium Dodecyl Sulfate-Polyacrylamide Gel Electrophoresis and Western blot using Leptospira-specific standard sera. To assess the diagnostic potential of rErpY, Ni-NTA affinity-purified protein was used to sensitize latex-coated beads (0.8 µm colour beads), which were then employed in the LAT for standardization and optimization with standard positive and negative sera. For evaluation, the rErpY-LAT was tested on serum samples from 177 suspected animal cases and compared to the microscopic agglutination test. It showed a relative diagnostic sensitivity of 90.6%, a specificity of 89.1%, and an overall accuracy of 90%. This study proposes rErpY-LAT as a field testing/screening diagnostic tool for preliminary serodiagnosis of leptospirosis, highlighting the potential of recombinant protein-based assays to address current diagnostic challenges.
The 2024 Forum on Domestic Violence and the Hague Abduction Convention
Authors: Barnett Adrienne , Kaye Miranda , Weiner Merle
Published: October 2024

This article discusses the recent Forum on Domestic Violence and the Operation of Article 13(1)(b) of the Hague Convention on the Civil Aspects of International Child Abduction sponsored by the Hague Conference on Private International Law. The article describes the reason for the Forum and highlights some of the important content that emerged at the event. It concludes with recommendations for the next Forum, scheduled to occur in Brazil during the second half of 2025.
Low latency carbon budget analysis reveals a large decline of the land carbon sink in 2023
Authors: Ke Piyu , Ciais Philippe , Sitch Stephen , Li Wei , Bastos Ana , Liu Zhu , Xu Yidi , Gui Xiaofan , Bian Jiang , Goll Daniel S , Xi Yi , Li Wanjing , O'Sullivan Michael , Goncalves De Souza Jefferson , Friedlingstein Pierre , Chevallier Frédéric
Published: October 2024

In 2023, the CO2 growth rate was 3.37 ± 0.11 ppm at Mauna Loa, which was 86% above that of the previous year and hit a record high since observations began in 1958, while global fossil fuel CO2 emissions only increased by 0.6% ± 0.5%. This implies an unprecedented weakening of land and ocean sinks, and raises the question of where and why this reduction happened. Here, we show a global net land CO2 sink of 0.44 ± 0.21 GtC yr−1, which is the weakest since 2003. We used dynamic global vegetation models, satellite fire emissions, an atmospheric inversion based on OCO-2 measurements and emulators of ocean biogeochemical and data-driven models to deliver a fast-track carbon budget in 2023. Those models ensured consistency with previous carbon budgets. Regional flux anomalies from 2015 to 2022 are consistent between top-down and bottom-up approaches, with the largest abnormal carbon loss in the Amazon during the drought in the second half of 2023 (0.31 ± 0.19 GtC yr−1), extreme fire emissions of 0.58 ± 0.10 GtC yr−1 in Canada and a loss in Southeast Asia (0.13 ± 0.12 GtC yr−1). Since 2015, land CO2 uptake north of 20°N had declined by half to 1.13 ± 0.24 GtC yr−1 in 2023. Meanwhile, the tropics recovered from the 2015–2016 El Niño carbon loss, gained carbon during the La Niña years (2020–2023), then switched to a carbon loss during the 2023 El Niño (0.56 ± 0.23 GtC yr−1). The ocean sink was stronger than normal in the equatorial eastern Pacific due to reduced upwelling from La Niña's retreat in early 2023 and the development of El Niño later. Land regions exposed to extreme heat in 2023 contributed a gross carbon loss of 1.73 GtC yr−1, indicating that record warming in 2023 had a strong negative impact on the capacity of terrestrial ecosystems to mitigate climate change.
Comparative efficacy and safety of talazoparib plus enzalutamide and other first-line treatments for metastatic castration-resistant prostate cancer
Authors: Castro Elena , Ellis Jenna , Craigie Samantha , Haltner Anja , Nazari Jonathan , Niyazov Alexander , Samjoo Imtiaz A
Published: October 2024

Background

Talazoparib plus enzalutamide (TALA + ENZA) has demonstrated antitumor activity in the phase 3 clinical trial (TALAPRO-2; NCT03395197) as first-line (1L) therapy in men with asymptomatic or mildly symptomatic metastatic castration-resistant prostate cancer (mCRPC). Although many active interventions are available, randomized controlled trials (RCTs) involving talazoparib have only been conducted to assess its efficacy and safety compared to enzalutamide. To estimate comparisons between all relevant interventions, indirect comparisons are needed.

Objective

To estimate the comparative efficacy and safety of TALA + ENZA in 1L patients with mCRPC by conducting a systematic literature review and network meta-analyses (NMAs).

Methods

Databases were searched using Ovid, along with several gray literature sources to identify RCTs evaluating treatments in 1L mCRPC (PROSPERO registration: CRD42021283512). Feasibility assessment evaluated trial suitability for NMA inclusion and Bayesian or frequentist NMAs were conducted for evaluable efficacy and safety outcomes, respectively.

Results

Thirty-three RCTs met the eligibility criteria and were feasible for NMAs. Across multiple efficacy outcomes assessed, except for overall survival (OS), TALA + ENZA was ranked the most efficacious treatment. For OS, TALA + ENZA showed the second-highest probability of being the most effective treatment; second to docetaxel 50 mg plus prednisolone 10 mg. With respect to safety outcomes, TALA + ENZA, in general, showed increased rates of hematological adverse events.

Conclusions

TALA + ENZA showed favorable results across multiple efficacy endpoints, but not across hematological toxicities compared with other 1L treatments in asymptomatic or mildly symptomatic mCRPC in the all-comers patient population.
Impact of the Lyα radiation force on super-Eddington accretion on to a massive black hole
Authors: Mushano Takuya , Ogawa Takumi , Ohsuga Ken , Yajima Hidenobu , Omukai Kazuyuki
Published: October 2024

The viability of super-Eddington accretion remains a topic of intense debate, crucial for understanding the formation of supermassive black holes in the early universe. However, the impact of the Ly$\alpha$ radiation force on this issue remains poorly understood. We investigate the propagation of the Ly$\alpha$ photons and evaluate the Ly$\alpha$ radiation force within a spherically symmetric accreting H i gas on to the central black hole. We solve the radiation transfer equation, incorporating the destruction processes of Ly$\alpha$ photons through two-photon decay and collisional de-excitation. We find that the Ly$\alpha$ photons, originating in the H ii region around black holes, suffer from multiple resonance scattering before being destroyed via two-photon decay and collisional de-excitation. Hence, the Ly$\alpha$ radiation force undergoes a significant amplification, surpassing gravity at the innermost section of the H i region. This amplification, quantified as the force multiplier, reaches approximately 130 and remains nearly constant, regardless of the optical depth at the line center, provided the optical thickness of the flow is within the range of $10^{10\\!-\\!14}$. The requisite lower limit of the product of gas density and black hole mass to realize super-Eddington accretion is found to be in the range $(2\\!-\\!40) \times 10^9\, M_\odot \, {\rm cm}^{-3}$, which is a few to tens of times larger than the minimum value obtained without accounting for the Ly$\alpha$ radiation force. The pronounced amplification of the Ly$\alpha$ radiation force poses a substantial challenge to the feasibility of super-Eddington accretion.
03 Best practice for transition from paediatric complex pain care: A scoping review
Authors: Ouellet Monica , Baerg Krista , Kaur Amanjot
Published: October 2024

Background

Many adolescent and young adults (AYA) experiencing chronic pain often continue to have pain in adulthood and thus must make the transition from paediatric care to adult care. Persistent pain and disability due to chronic pain throughout young adulthood can disrupt the attainment of important developmental milestones at transition to adulthood that impact quality of life. Inadequate transition planning may be associated with poor health outcomes and increased health utilization. However, only few studies have described the specific transition protocol from paediatric to adult care that AYA with chronic pain must make.

Objectives

To improve understanding of transitional care needs during transition planning and after transition (quality of care), this paper will determine known barriers to successful transition from paediatric chronic pain care to adult care as well as factors associated with successful transition from paediatric multidisciplinary paediatric chronic pain care, identify patient care needs at transition from paediatric chronic pain care, and finally describe the best practice (existing frameworks) to support youth at transition from paediatric chronic pain care.

Design/Methods

This scoping review used previously published Arksey and O’Malley framework and followed the PRISMA guidelines. It sought to answer the following questions. What are the barriers to successful transition and what factors are associated with successful transition from paediatric chronic pain care to adult care? What are patient care needs at transition from paediatric chronic pain care? How can we best support youth at transition from interdisciplinary paediatric chronic pain care? A literature search was carried on Ovid Medline and 12 studies (11 research articles and 1 dissertation) published from 2015 to 2022 were included in the review, with only one theoretical transition framework that may be useful in the Canadian healthcare setting.

Results

In this scoping review, interpersonal, organizational, and systemic barriers and enablers for successful transition were identified. The most frequently identified barriers to successful transition include lack of self-efficacy, trust, communication, coordination of care between paediatric and adult care. A need of early transition, an individualized approach, fluid and dynamic transition process, and age-appropriate resources were identified as primary patient care needs during transition. Four frameworks supporting transitional care for AYA with chronic health conditions were identified.

Conclusion

Limited evidence suggests that there is lack of standardized transition protocol for clinical use. There is an urgent need for an evidence-based transition tools for clinical use for AYA with chronic pain.
13 Child maltreatment in Canada in the time of COVID-19: Experiences of child protection teams
Authors: Dixon J Andrew , Laberge Marie , Chauvin-Kimoff Laurel , Morantz Gillian
Published: October 2024

Background

At the onset of the COVID-19 pandemic, there were many fears regarding the effect on children’s wellbeing – specifically with regards to increased exposure to violence and potential for abuse and neglect within their homes. Early experiences of child protect teams (CPT) in the literature from one Canadian tertiary care center revealed a number of adaptations in their child abuse programs such as a move toward virtual assessments.

Objectives

Our descriptive study seeks to understand the perspectives, practices, and experiences of child protection teams in Canada during the COVID-19 pandemic with regards to: clinical practice, interactions with child welfare organizations and the justice system, team modes of operating and medical education. These lessons can be applied to child maltreatment and neglect clinical practice in the event of future pandemics, natural disasters, and to provide care to rural areas of Canada.

Design/Methods

Using a web-based, bilingual, mixed methods survey, we asked both quantitative and open-ended qualitative questions to members of CPTs across Canada. Thematic analysis was completed on qualitative responses. We received a total of 11 responses.

Results

Respondents unanimously reported a decrease in referrals during the COVID-19 pandemic. 64% endorsed the use of new virtual tools. Virtual tools were used to collaborate amongst members of the CPT as well as with external partners (such as child welfare and justice system). Interestingly, there was minimal adaptation of these tools in patient-facing contexts. 57% of respondents foresee these tools to continue being used in a post-COVID-19 context, and 71% see relevance of these tools for use in rural contexts. Respondents reported that virtual clinical discussions changed the way medical education and case discussion in child maltreatment was delivered.

Conclusion

These findings describe not only the adaptation of child protection teams to the pandemic, but also robust changes to clinical practice, interactions with partner organizations and the justice system, team modes of operating and medical education in child maltreatment and neglect in Canada.
14 Exploring factors contributing to Secondary Traumatic Stress in residents during a child maltreatment paediatrics rotation
Authors: Bal Chandandeep , Yeung Frances , Smith Jenny , Cho Romy
Published: October 2024

Background

Secondary Traumatic Stress (STS) refers to the distress and emotional disruption experienced by individuals caring for those who have experienced trauma. STS is increasingly recognised in child serving professions, especially in medical trainees and clinicians working in Child Maltreatment Paediatrics (CMP). Paediatric resident physicians are typically of younger age, work long hours in stressful conditions, and have limited CMP experience. This makes them particularly vulnerable to experiencing STS. In addition to affecting the wellbeing of trainees, STS can impede performance at work and affect patient care. Thus, it is important to understand and mitigate the development of STS among paediatric trainees during their CMP rotation.

Objectives

This study aims to identify key factors contributing to STS among medical residents at a tertiary care paediatric hospital during a CMP rotation.

Design/Methods

Qualitative interviews and focus groups were conducted to explore the experiences and perceptions of CMP trainees, staff physicians, and psychologists. Quality Improvement methods including a Fishbone diagram (figure 1), 5-whys analysis, and Pareto analysis (figure 2) were used to analyze the factors that contribute to residents developing STS symptoms.

Results

Our analysis revealed the following themes contributing to STS symptoms in paediatric residents: (1) limited awareness and education on STS symptoms, (2) lack of planned case debriefing, (3) residency-related burn out, (4) limited experience in CMP, (5) hidden curriculum of residency, and (6) limited opportunity to discuss STS symptoms.

Conclusion

Our study identified factors related to both limited knowledge around STS, and limited opportunities to debrief cases that may contribute to the development of STS among residents. These factors can, in part, be addressed on a program level. This aligns with existing STS literature which emphasizes implementing program level strategies to support professionals in addition to prioritizing self-care. Next steps involve implementing targeted interventions within the rotation to help mitigate STS effects on trainees.
16 Caring for children with medical complexity beyond the hospital: The work life experiences of nurses in homecare
Authors: Pitch Natalie , Mekhuri Sam , Keilty Krista , Chu Stephanie , Patel Richa , Shin Abigail , Orkin Julia , Amin Reshma
Published: October 2024

Background

Homecare nursing is considered essential to the care for children with medical complexity (CMC) given their intense daily care demands and dependence on medical technology. While patients, families, and healthcare providers (i.e., paediatricians, nurse practitioners) rely on homecare nurses (HCNs), there is limited research exploring factors that either promote or challenge the ability of HCNs to provide safe and satisfactory care in the home environment.

Objectives

This study aims to gain a thorough understanding of HCNs’ experiences caring for CMC. Specifically, we aimed to explore both the facilitators and barriers to feeling well-equipped for the role, developing relationships with families, and providing high quality care.

Design/Methods

We conducted semi-structured interviews between March 2021-March 2023 with HCNs caring for CMC using medical technology (e.g., home ventilation, central venous access devices). Interview questions explored the HCNs’ clinical experiences and education in the use of medical technology, relationships with family caregivers, rewarding and challenging aspects of their work-life, and recommendations to improve their experience in homecare nursing. Interviews were audio recorded, deidentified, transcribed verbatim, coded and analyzed using content analysis.

Results

Twenty-one semi-structured interviews were conducted. The interviews revealed two major themes and several associated subthemes: (1) the unique experiences of a homecare nurse (patients’ homes as the workplace, obstacles to delivering care, toll on emotions, and rewards of the role); and (2) interactions with patients and their families (facilitators of building partnerships and challenges to relationships).

Conclusion

Homecare nursing for CMC is rewarding, providing opportunities for HCNs to develop meaningful connections with their patients while also supporting families. However, HCNs experience several challenges including inconsistent training, inadequate resources, and conflicts with families. Understanding the perspectives of HCNs is critical to improving their experience in the role, and in turn, enhancing care for their patients. These findings can inform the development and implementation of supports needed to optimize the work experience for HCNs.
17 Caregiver experiences with enteral feeding transitions
Authors: Chawla Raman , Dewan Tammie , Montgomery Lara , MacKay Lyndsay , Spicer Sharron , Turner Justine
Published: October 2024

Background

Children with medical complexity (CMC) are an expanding group within paediatrics due to advances in medical care, often including a dependence on medical technology. Issues such as oromotor swallowing dysfunction and feeding difficulties are common in this population. As a result, many CMC require the use of enteral tubes for feeding. While evidence does support improved nutritional status with the use of enteral feeding tubes, there is limited literature discussing how these interventions impact other patient centered outcomes, such as quality of life for the child, changes in parental caregiving, and logistical implications for the family. A comprehensive understanding of the positive and negative outcomes associated with selection and transition between different feeding tube options is needed.

Objectives

To describe and explore the caregiver and patient experience with different feeding tubes, with a focus on the experience of transitioning between different enteral feeding modalities.

Design/Methods

We conducted semi-structured interviews with 16 participants, including both caregivers and two patients. Reflexive thematic analysis was utilized to identify preliminary themes from interviews. Themes were further refined by the study team.

Results

The themes identified through interviews included: A) the pros and cons with each type of enteral feeding modality, B) the emotional impacts on patients and caregivers, C) logistical impacts on day-to-day life for families, and D) the experience of transitioning between feeding tubes. Globally, participants spoke positively about their transition from nasogastric feeding to either gastrostomy or gastrojejunal feeding tubes. Caregivers also felt that they were integral to the decision-making process, though some felt in hindsight the transition process was too slow.

Conclusion

This study highlights both the complexity and heterogeneity of the caregiver experience with different feeding tubes. It found that most families consistently viewed their transitions with enteral feeding tubes positively, as this was seen as a significant milestone in helping their child both nutritionally and with their quality of life. Finally, further research could be done to explore experiences with gastrojejunal and jejunal feeding, as this patient population is not well elucidated within the literature.
31 Impact of the amount of intravenous glucose administration on hospitalization for acute gastroenteritis in a paediatric emergency department
Authors: Santamaria Christina , Peloquin Fannie , Mousseau Sarah , Gravel Jocelyn
Published: October 2024

Background

In case of failure of oral rehydration, children with acute gastroenteritis can be hydrated using intravenous (IV) solution. The choice of the intravenous solution itself (solutions containing dextrose versus crystalloids alone) and the glucose quantities to administer are not well established.

Objectives

The main objective of this study was to evaluate the impact of the amount of intravenous glucose provided to children treated for acute gastroenteritis on hospitalizations. Other objectives were to evaluate practice variation regarding the amount of glucose and liquid provided for IV rehydration in a paediatric emergency department (ED).

Design/Methods

We conducted a retrospective cohort study from 2019-2022 in a Canadian paediatric ED. We included children with acute gastroenteritis undergoing IV rehydration. Patient with hypoglycemia, metabolic disease or diabetes were excluded. The IV glucose administered during the initial four hours of rehydration was quantified. The primary outcome was hospitalization and return visit in the following seven days was a secondary outcome. 10% of the charts were evaluated in duplicate to assess inter-rater reliability. We examined glucose distribution at one and four hours, and utilized multiple logistic regression to relate glucose amounts with hospitalization and second visit, accounting for age, weight, bicarbonate levels, ondansetron use, and amount of liquid infused. It was estimated that the evaluation of 250 cases would have at least 50 admissions.

Results

Among 6,939 children evaluated for potential acute gastroenteritis, 250 met our inclusion/exclusion criteria. All variables included in the analysis had excellent inter-rater reliability. Notable variations existed in glucose quantities provided, both at one hour (first quartile: 87 mg/Kg; third quartile: 294 mg/Kg) and four hours (first quartile: 681 mg/Kg; third quartile: 1174 mg/kg) of rehydration. Multiple logistic regression showed a greater hospitalization risk with smaller amount of glucose administered during the initial hour (OR for each 100mg/kg increment: 0.60; 95%CI: 0.42-0.84) and four hours (OR: 0.76; 95%CI: 0.63-0.91) of rehydration. Moreover, children who received more dextrose during the first hour of rehydration were at lower risk of return visit (OR for each 100mg/kg increment: 0.52; 95%CI: 0.35-0.78), as well as during the first four hours (OR for each 100 mg/kg increment: 0.83; 95%CI: 0.73-0.94).

Conclusion

There was a wide practice variation in intravenous glucose provided to children with acute gastroenteritis. In this population, higher intravenous glucose amount was associated to a lower risk of hospitalization and lower risk of return visit.
32 A randomized controlled trial of virtual reality-based distraction for intravenous cannulation-related distress in children
Authors: Hudson Summer , Rajagopal Manasi , Gourlay Katie , Hartling Lisa , Stinson Jennifer , Ma Keon , Vandermeer Ben , Schreiner Kurt , Ali Samina
Published: October 2024

Background

Children commonly experience under-treated pain and distress related to medical procedures, such as intravenous insertions (IVI), leading to both short- and long-term negative consequences for patients and their caregivers. Virtual reality (VR) has emerged as a promising tool to ameliorate procedure-related distress in the paediatric healthcare setting; however, existing evidence has largely employed custom VR software, which can be expensive and inaccessible. As such, we aimed to characterize whether commercially available VR applications are effective in reducing children’s procedure-related distress.

Objectives

To assess the effectiveness of commercially available VR-based distraction when added to standard of care (SOC, which included topical anesthetic cream), in reducing distress for children undergoing IVI in the paediatric emergency department (PED).

Design/Methods

Children aged 6 to 17 years requiring IVI in a Canadian PED were recruited for a two-arm randomized controlled trial. The primary outcome was child distress, measured using the Observational Scale of Behavioural Distress – Revised (OSBD-R, score range 0-23.5). Secondary outcomes included child pain intensity (measured with the Faces Pain Scale-Revised, score range 0-10) and caregiver anxiety [measured by the State-Trait Anxiety Inventory-State (STAI-S), score range 20-80] during the procedure. Trial registration number: NCT04291404C.

Results

82 children and their caregivers were included. 41 children received VR distraction in addition to SOC (mean age 10.8 years, SD 3.0), while 41 children received SOC alone (mean age 11.3 years, SD 2.8). There was no significant difference between OSBD-R-measured distress in the VR arm (mean 1.05, SD 1.52) compared to the SOC arm (mean 0.71, SD 1.40) (p = 0.08). There was no significant reduction in procedural pain intensity in the VR group (mean 4.20,SD 3.10) compared to the SOC group (mean 4.10, SD 3.20) (p = 0.85). There was no difference in caregiver STAI-S score immediately following IVI in the VR arm (mean 32.3, SD 11.3) versus the SOC arm (mean 32.3, SD 11.9) (p = 0.86).

Conclusion

VR distraction therapy employing commercially available software was not associated with reduction in procedural distress or pain, above that provided with SOC in the PED, for children undergoing IVI. This result highlights the need for more accessible custom VR distraction software, created to meet the unique psychological needs of children undergoing medical procedures. Further study is needed to directly compare custom versus commercially available VR software for this application.
48 Evaluation without representation: Paediatric residents perspectives on CBME
Authors: Anzinger Harrison , Schrewe Brett
Published: October 2024

Background

Paediatrics transitioned in 2021 to Competence By Design (CBD), a postgraduate education model spearheaded by the Royal College of Physicians and Surgeons of Canada (Royal College). CBD replaced a time-based training system with one based on competencies demonstrated through regular observations of trainee performance. Although intended to be learner-centered, resident voices have been underrepresented in CBD’s design.

Objectives

We sought to (1) understand how paediatric residents perceived CBD as impacting their education and evaluation, and (2) explore their ideas to improve its implementation.

Design/Methods

We compared three Canadian postgraduate paediatric residency programs. First, we reviewed Royal College and program-specific documents regarding CBD to understand local and national priorities for its implementation. Program directors and local education leads were then interviewed to understand local priorities and implementation practices at these programs. Lastly, we conducted interviews with paediatric residents that began residency the year that CBD was launched. We used reflexive, inductive analysis to analyze their perspectives on how CBD has affected their education and develop learner-informed recommendations for improvement.

Results

We interviewed six program directors and CBD leads. Identified programmatic benefits included improved trainee surveillance, facilitated curriculum change, and competency committees. Challenges included untrained faculty, workplace-based assessment tensions, and administrative burden on residents and staff. Subsequent interviews with ten paediatric residents demonstrated CBD as having limited benefit to their education, leading to a checklist mentality of EPA completion and disengagement with the CBD system. These perceptions were influenced by (1) administrative burden, (2) poor quality feedback from disengaged staff with limited coaching experience, and (3) a lack of collaborative communication between the residents, their programs, and the Royal College. Residents suggested improvements, including: decreasing the number of assessments to alleviate time burden on both residents and faculty; implementing formal coaching instruction for residents and staff; and improving dialogue between Royal College, competency committees, and residents and physician evaluators to build buy-in with the system and facilitate continuing process improvement.

Conclusion

If we are to effectively adapt postgraduate educational systems to equip learners with the skills to meet the needs of the societies they serve, centering resident voices in curricular revision is paramount to maximize learner buy-in, minimize unintended administrative burden, and guide the development of necessary institutional supports (e.g., formal coaching) to ensure successful system transformation.