bluuebunny/crossref_metadata_2025 huggingface dataset:
Solar horizontal flow evaluation using neural network and numerical simulations with snapshot data
Authors: Masaki Hiroyuki , Hotta Hideyuki , Katsukawa Yukio , Ishikawa Ryohtaroh T
Published: September 2023

We suggest a method that evaluates the horizontal velocity in the solar photosphere with easily observable values using a combination of neural network and radiative magnetohydrodynamics simulations. All three-component velocities of thermal convection on the solar surface have important roles in generating waves in the upper atmosphere. However, the velocity perpendicular to the line of sight (LoS) is difficult to observe. To deal with this problem, the local correlation tracking (LCT) method, which employs the difference between two images, has been widely used, but this method has several disadvantages. We develop a method that evaluates the horizontal velocity from a snapshot of the intensity and the LoS velocity with a neural network. We use data from numerical simulations for training the neural network. While two consecutive intensity images are required for LCT, our network needs just one intensity image at only a specific moment for input. From these input arrays, our network outputs a same-size array of a two-component velocity field. With only the intensity data, the network achieves a high correlation coefficient between the simulated and evaluated velocities of 0.83. In addition, the network performance can be improved when we add LoS velocity for input, enabling us to achieve a correlation coefficient of 0.90. Our method is also applied to observed data.
L’évaluation et la prise en charge de l’énurésie en pédiatrie générale
Authors: Harris James , Lipson Alisa , Dos Santos Joana
Published: September 2023

Pour évaluer l’énurésie, un trouble pédiatrique courant, il faut en distinguer la forme monosymptomatique de la forme non monosymptomatique et établir la présence d’affections concomitantes. La prise en charge simultanée des facteurs cooccurrents est le meilleur moyen pour obtenir un résultat satisfaisant. Le traitement commence par l’éducation du patient et de sa famille sur l’évolution naturelle de l’énurésie et par des conseils pratiques sur le comportement. Les données probantes en appui à des interventions particulières sont limitées, et les enfants et les familles devraient participer au choix du traitement approprié. Les dispositifs d’alarme contre l’énurésie et la desmopressine représentent des possibilités thérapeutiques lorsqu’une intervention plus active est souhaitée. Des améliorations cliniques et des traitements combinés sont en voie de se dégager.
4 Adolescents Identifying their Barriers to Access Mental Health and Addiction Services in a Small Rural Canadian Town
Authors: Ortiz-Alvarez Oliva , Cozzi Regina , Blackburn Heather , Marmura Hana
Published: September 2023

Background

Mental health illnesses or disorders and addictions are common in the Canadian population. Despite the huge burden associated with child and adolescent mental health disorders around the world, in Canada and in our local communities there are gaps in the provision of care for this population. Teenagers are particularly vulnerable to the inadequate provision of care, as services have been traditionally conceptualized to serve the needs of children and adults. The gap between need and access to mental health and addiction services has been identified by: parents, teachers, and health care providers, albeit mostly studied in large urban populations.

Objectives

The purpose of the study was to identify the adolescent-perceived barriers to accessing mental health services in the community.

Methods

We conducted a cross-sectional study in a small rural town through online questionnaires, asking local high school students to report their perceived personal and community level barriers to accessing services. The sample included 244 high school students answering the questionnaire, which included sections on perception of individual level barriers and perception of community level barriers. We also captured respondent characteristics, including demographics, attempts to access mental health services in the past, and awareness of resources.

Results

Respondents’ top perceived barriers were the lack of awareness regarding available resources, lack of proper education regarding mental health issues, and uncertainty of what the treatment would entail. Students who had previously accessed services identified the lack of qualified mental health professionals, frequent change of mental health professionals, and lack of collaboration and communication among service providers as their top barriers, whereas students who had not accessed services reported the uncertainty of the treatment, fear of social stigma, and exclusion as primary barriers.

Conclusion

The study findings strongly support the need for promoting better mental health literacy in the school and in the community as well as improving the services available. A critical look at the mental health curriculum components across the grades is urgently needed. Planning mental health services addressing these perceived barriers might improve teenagers’ access to services, allowing those in need to seek help and receive effective treatment before they are in crisis.

Potential competing interests

Received funding from MicroResearch and Saint Martha's Foundation
10 Paediatricians’ Awareness of Canadian Screen Time Guidelines, Perception of Screen Time Use, and Counseling during the COVID-19 Pandemic
Authors: Amos Kiersten , Ens Andrea , Ogilvie Jacqueline , Ponti Michelle , Miller Michael , Yang Fanyu
Published: September 2023

Background

Paediatricians are essential for guiding families on screen time use as digital media become increasingly prevalent, particularly through the COVID-19 pandemic. However, there is no literature on paediatrician awareness of Canadian guidelines or on perception of these guidelines during the pandemic.

Objectives

The aim of this study was to assess the knowledge, attitudes, and comfort of paediatricians with the Canadian Paediatric Society’s (CPS) screen time guidelines, specifically during the COVID-19 pandemic.

Design/Methods

Our survey was developed by a paediatric resident and paediatric endocrinologist, reviewed by local experts, and sent electronically to members of the Community and Developmental Paediatrics Sections of the CPS.

Results

All 53 respondents were aware of current CPS screen time guidelines, and the majority had fair to excellent knowledge of guidance for both age groups (<5 years, and school-aged children and adolescents). Over 80% noticed increased screen time use during the pandemic, and 98% were somewhat or very concerned about screen time use and their patients’ health or well-being. Qualitative data indicated paediatricians were concerned about associations between increased screen time with worsening behaviour, mental health concerns, obesity, and sedentary lifestyle. The greatest implementation barrier was perceived to be insufficient motivation or support from caregivers/families.

Conclusion

Our study demonstrates that paediatricians are highly knowledgeable and comfortable with current screen time guidelines, and frequently counsel their patients accordingly. Despite this, paediatricians are increasingly concerned with negative health outcomes associated with screen time use. We hope these results empower paediatricians to continue counseling patients and encourage further local advocacy and public education around increased screen time and related health risks in children.
11 Experiences of Inpatient Healthcare Services among Children with Medical Complexity: A Scoping Review
Authors: Asaad Lauren , Dewan Tammie , MacKay Lyndsay , Buchanan Francine , Hayden Alix , Montgomery Lara
Published: September 2023

Background

Children with medical complexity (CMC) have among the highest need for inpatient services in paediatrics. In addition to effectiveness and safety, experience of care (EoC) is a crucial pillar of health care quality, encompassing all interactions that shape a patient/family’s perception of care. Current evidence suggests that CMC have lower EoC compared to other populations. Collating the existing cross-disciplinary evidence will identify critical aspects of their EoC, both positive and negative, that could inform the development and evaluation of health services interventions for CMC in the hospital setting.

Objectives

The objectives of this scoping review were to map the existing literature related to the experience of inpatient health services for CMC and their families, describe research methods, and categorize key concepts of EoC while simultaneously identifying knowledge gaps.

Design/Methods

The Joanna Briggs Institute (JBI) methodology for scoping reviews was used. Articles related to CMC and the inpatient setting were identified through EMBASE, CINAHL, Web of Science, MEDLINE and PsychoInfo. Reference lists were also searched for relevant articles. Screening of titles, abstracts, and full-text articles was conducted by two independent researchers, resolving discrepancies by discussion and consensus. Data extraction and critical appraisal for included papers were likewise conducted by two separate researchers. Abstracted data included authors, participants, objectives, methodology, and key findings. Critical appraisal was conducted using the Mixed Methods Appraisal Tool and the JBI critical appraisal tool for systemic reviews.

Results

A total of 4463 separate articles underwent title/abstract review and 513 went on to full text review. After applying inclusion and exclusion criteria, a total of 48 articles was included in the review. There were 26 qualitative studies, 8 quantitative studies, 7 mixed methods studies, and 7 review papers. Quantitative studies used a variety of instruments to measure EoC, with the most common being the Measures of Processes of Care. The primary concepts related to EoC to be identified include partnerships (including continuity, building a therapeutic alliance), communication (particularly parent-nurse), decision-making and goal setting, and psychological distress and symptoms that occur during a hospitalization.

Conclusion

This review synthesizes the existing evidence on inpatient EoC for CMC. Although a diverse set of elements related to EoC are described, there are few interventional studies that include these as outcome measures. These EoC elements could be mapped to existing instruments or form the basis for the development of new tools that would allow the incorporation of EoC into evaluation of inpatient interventions.
16 Autistic Perspectives on the Acceptability of Paediatric Autism Therapies
Authors: Caven Isabelle , Penner Melanie
Published: September 2023

Background

Autistic children and their families access services, such as occupational therapy (OT), speech language pathology (SLP) services, applied behaviour analysis (ABA)-based therapies and physiotherapy (PT). There are varying levels of evidence supporting the efficacy of these therapies, and some autistic-led advocacy is critical of the methods and aims of certain services. Exploring stakeholder perspectives is critical to ensure services are appropriate and informed by lived experiences. This work is part of a larger survey that explored the perspectives of autistic individuals, parents of autistic children, and clinicians on these services.

Objectives

This study explored how autistic people perceive the acceptability of OT, SLP services, ABA-based therapies, and PT.

Design/Methods

Using the Theoretical Framework of Acceptability (TFA), a survey was built with input from autistic people, parents of autistic children, and clinicians and shared online through social media and autism organizations. Demographic data and perspectives were captured. An acceptability sub-score was produced for each therapy, ranging from 0 (least accepting) to 64 (most accepting). The sub-scores were combined into an overall acceptability score. Open-ended questions were qualitatively analyzed using deductive content analysis following the TFA, and categories within constructs of ethicality are presented.

Results

21 autistic people completed the survey, and their median (range) sub-scores were OT 40 (16 – 56), SLP 43.5 (28 – 57), ABA 19.5 (8 – 48), PT 39.5 (28 – 57). Qualitative categories within the TFA construct of ethicality included: 1) concerns about harms and negative experiences that can potentially occur because of therapies; 2) a lack of support for what respondents identified as behavioural techniques or methods.

Conclusion

Findings are similar to existing perspectives that some autistic people have towards ABA-based therapies. However, these findings highlight that some autistic people may view any therapy as unacceptable if it incorporates behavioural methods. Further work is needed to better understand aspects of behavioral methods that are viewed as unacceptable, given that some strategies, such as positive reinforcement, are used in different therapies and with the general population. Future work should explore perspectives from larger samples.

Potential competing interests

Melanie Penner has received consulting fees from the province of Nova Scotia and Addis & Associates / Roche, and research grant funding from Autism Speaks.
19 Characterization of Neurodevelopmental Comorbidities within a Paediatric Population with a First Epileptic Seizure
Authors: Leduc Bertrand , Diadori Paola , Major Philippe , Gagné Jennifer , Bitton Jonathan , Aboulamer Soumia , Beetz Gabrielle
Published: September 2023

Background

Epilepsy is the most common paediatric neurological disorder. An estimated 4% of the general population will have an unprovoked epileptic seizure at least once in their lifetime. Of these, about 40% will experience a recurrence within two years. The International League Against Epilepsy (ILAE) established that one part of the definition of epilepsy was the onset of a first seizure with a recurrence risk of more than 60% over 10 years. However, except for epileptiform abnormalities and a structural-metabolic etiology present on the electroencephalogram (EEG), very few known factors are consistently associated with first epileptic seizures.

Objectives

Our study’s objective was to characterize neurodevelopmental comorbidities, namely attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), anxiety, depression, gross motor delay and language delay, in patients following a first epileptic seizure as compared to healthy controls.

Design/Methods

Children referred in neurology for a first suspected epileptic seizure, between June 2016 and June 2018 at the Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), underwent EEG and neurological evaluations. For screening of comorbidities, parents completed age-appropriate M-CHAT-R/F, SCQ, ASQ-3, SCARED, and CES-DC questionnaires via a web platform adapted from CHADIS. Questionnaire scores were adjusted for age and sex and analyzed via a Student’s t-test. The prevalence of comorbidities was analyzed via a chi-square statistical test.

Results

A total of 72 subjects aged between 1 month and 18 years (42 males, 30 females) were enrolled in the study. Patients with a first epileptic seizure (n=37) showed significantly more comorbidities compared to the healthy subjects (54% vs. 31%, p<0.05). Patients with a first epileptic seizure had significantly more language delay (50%, p=0.015), ADHD (45%, p=0.008), and a significantly higher score in the Social Communication Questionnaire (SCQ) (p=0.03), compared to healthy subjects.

Conclusion

Our results confirm the increased rate of comorbidities in children with a first epileptic seizure and, thus, the importance of concomitant screening for those disorders at the time of the initial presentation.
22 Families’ Experiences with Autism Service Navigation and Mobile Application-based Support
Authors: Young Elizabeth , Jegathesan Thivia , Nallathamby Shanthiya , Wagner Rachel , Minhas Ripudaman , Penner Melanie
Published: September 2023

Background

Navigating services following an autism spectrum disorder (ASD) diagnosis is a challenging and lengthy process. Families of children with ASD increasingly experience difficulty locating and accessing services, leading to the inaccessibility of care. These difficulties were further exacerbated by COVID-19 and little is known about families' experience navigating services during the pandemic. Given the complexities of accessing publicly funded developmental services and the lack of a comprehensive platform to navigate available services, prior to the pandemic our research team developed a mobile application, My Autism Passport (MAP), to assist families in identifying publicly available ASD services. Our goal was to determine whether a mobile application would provide families with greater self-efficacy during these challenging times.

Objectives

The primary objective of our study was to determine the impact of MAP on caregiver self-efficacy.

Design/Methods

A randomized controlled trial of 34 caregivers of children under 6 years of age who were given a new diagnosis of ASD in the last year were recruited into the study. 17 were randomized to receive MAP. Access to ASD services and parent self-efficacy scores were collected via questionnaires at baseline and then at 6 months from recruitment in both groups. Self-efficacy was measured using the Parent Empowerment and Self-Efficacy Measurement (PEEM).

Results

Our study consisted of an ethnically diverse group of participants with varying socioeconomic levels. At baseline, participants indicated an overall mean PEEM score of 131.8 (±28.2) in the control arm, and 138.5 (±23.3) in the App arm at the time of diagnosis (p-value 0.6149). At 6 months following ASD diagnosis, the overall score was 123.2 (±35.7) in the control arm, and 137.3 (±33.3) in the App arm (p-value 0.4413). There was a trend towards decreasing feelings of self-efficacy in the control group compared to those with the App who had a stable self-efficacy score.

Conclusion

Our study indicates that the use of a mobile app to assist service navigation may be helpful for families in self-navigation for autism services. Data collection and analysis are ongoing for one-year post-diagnosis.
27 EDI Practices Amongst Academic Leaders at a Tertiary Paediatric Centre
Authors: Johnson Natasha , Johnson Kassia , Kam April , Khan Sarah , Wahi Gita , Lacy Megan
Published: September 2023

Background

Our university’s strategic approach to Equity, Diversity and Inclusion (EDI) includes institutional capacity and commitment. Embedded within this pillar is the establishment of “systems, structures and policies that sustain EDI commitments through leadership, governance and accountability”.

1.Objectives: To ascertain baseline EDI practices of Division Leaders and the Department Executive Team

2.To identify prioritized training/learning needs early in the tenure of the inaugural Associate Chair, EDI

Design/Methods

An anonymized, 10 question electronic survey was distributed to division leads and executive team members with the Department of Paediatrics.

Results

An electronic survey was distributed to 22 people and 14 responded (64% response rate).

Only 21% of leaders included a land acknowledgement at the beginning of their division, portfolio, or committee meetings. Reasons for not doing so included:

• Meetings are informal or have few people

• Worried about tokenism/checking a box

• Had not thought to do so

29% of leaders have a standing “EDI matters” agenda item for their division, portfolio, or committee meetings. Reasons for not doing so included:

• Attempting to incorporate EDI principles into work

• Addressing EDI items as they occur

• Unsure how to engage in meaningful action

• Had not thought to do so

The majority of leaders who responded, 79%, completed bias education and/or training. All the respondents want more, or specific, EDI training for their division(s) or portfolio(s). Racism was identified as the #1 equity issue urgently impacting divisions or teams. Other priority areas identified included: 2SLGBTQIA+, gender equity, Indigenous reconciliation, and employment bias. Other themes that were raised included:

• Equitable healthcare access

• Representation at decision-making tables

• Gender bias impact on career and work opportunities

• Bias in the workplace

• Becoming an antiracist organization

• Engaging everyone in antiracist work

• Systemically embedding EDI principles

• Equitable opportunities and support for all employees

That 36% of department leaders did not respond to our brief EDI survey may need to be explored further.

Conclusion

Most leaders are not routinely doing land acknowledgments or incorporating EDI into agendas as a standing item. All expressed a desire for more EDI training. Survey responses informed priorities for the first term of the Inaugural Associate Chair, EDI. An EDI-focused Grand Rounds Series and an EDI SharePoint site were created. Leaders are encouraged to make EDI awareness integral to daily tasks from initial recruitment. Our Anti-Racism Coalition’s version of the Power Flower (Figure 1) was shared to enhance awareness of various power differentials at play.
29 Assessing Paediatric Trainees’ Confidence in Providing Culturally Responsive Care to Patients
Authors: Chen Anna , Blatman Zachary , Chan Amy , Hossain Anna , Niles Chavon , Atkinson Adelle , Narang Indra
Published: September 2023

Background

Extensive data consistently demonstrate inequities in access and delivery of healthcare for patients from historically marginalized populations, resulting in poorer health outcomes. To address systemic oppression in healthcare, it is necessary to embed principles of equity, diversity, and inclusion (EDI) within medical education. Currently, limited data exist regarding paediatric trainees’ interest in EDI curricula and confidence in applying this knowledge to provide culturally responsive care.

Objectives

To assess paediatric trainees’ confidence in applying EDI knowledge to provide culturally responsive care to children and youth from historically marginalized communities.

Design/Methods

An anonymous online survey was distributed to paediatric trainees at a Canadian paediatric tertiary care centre during the 2021/22 academic year. Closed-ended questions used a Likert scale to assess respondents’ confidence and interest in providing culturally responsive care to patients. Open-ended questions explored trainees’ perceptions of effective EDI learning modalities. Quantitative data was summarized using descriptive statistics. Descriptive content analysis was used to highlight themes within qualitative data.

Results

116 paediatric trainees completed the survey, of which 72/116 (62%) were subspecialty residents/fellows and 44/116 (38%) were core residents. Nearly all respondents indicated importance (mean 97%) and interest (mean 95%) in learning about providing culturally responsive care to patients from historically marginalized communities. However, many trainees lacked confidence in their knowledge of providing culturally responsive care (mean 51%) and applying their knowledge in clinical practice (mean 53%). Respondents identified direct clinical exposure through rotations, immersive experiences, and continuity clinics as effective EDI teaching modalities. Identified barriers included time constraints in the clinical environment, burnout, and lack of exposure to diverse patient populations.

Conclusion

Most paediatric trainees want to provide culturally responsive care to patients from historically marginalized communities, but do not feel confident in their knowledge to do so. These study findings will be utilized to develop and implement an enhanced EDI education curriculum for both core trainees, as well as subspecialty residents and fellows, across the Department of Paediatrics.
30 Promoting Child and Youth Rights Literacy and the United Nations’ Convention on the Rights of the Child (UNCRC) for Equity-deserving Populations: A Multi-Partner, Mixed Methods Pilot Study
Authors: Grover Sanya , Binda Catherine , Lau Will , Beevor-Potts Amy , Bondi Lauren , Gill Sabrina , Ritland Lisa , McFadden Alysha , Bland Clea , Duffy Damian , Carwana Matthew , Hodgson Kate , Vaghri Ziba , Loock Christine
Published: September 2023

Background

The UNCRC outlines the rights of children and youth to develop their greatest potential. These rights provide a framework for a child-centred approach in paediatric clinical practice and are associated with improved patient outcomes and experiences. While these rights are increasingly acknowledged globally, more work is needed within clinical settings to adopt this rights-based approach. A pilot survey was developed in partnership with an equity-deserving urban youth recreation centre and youth with chronic health conditions from a provincial paediatric tertiary care teaching hospital’s Youth Advisory Committee (YAC) regarding their knowledge of, and access to, the UNCRC.

Objectives

1) To identify urban community youth knowledge of, and access to, UNCRC; 2) To identify and compare YAC knowledge of, and access to, UNCRC.

Design/Methods

Ethics approval was obtained. A survey developed to facilitate UNCRC discussions was presented to the urban community youth, iteratively from 2020 to 2021. Participants were recruited using convenience snowball sampling. Zoom dialogues between the research team and YAC members were held to adapt the survey to YAC context. The survey was completed by YAC members on Qualtrics from May to August 2022. Demographic information and survey results were analyzed using descriptive statistics.

Results

57 participants completed the survey, including 18 youth, 16 caregivers, and 11 staff members from the community, and 11 youth and 1 staff member from YAC. The median ages of urban and YAC youth were 16.4 years and 23 years respectively. Prior to the study, 70% of youth participants did not know, or only sort of knew that the UNCRC existed. Both urban youth and YAC reported that children aged 0 to10 and 11 to 14 have the most access to article 31 (rest and play). However, urban youth reported that 15 to24-year-olds have the most access to article 24 (health and health services), whereas YAC reported article 12 (respect for children’s views) for this age group. Both youth groups reported that children and youth of all ages have the least access to articles 28 and 29 (education), article 12 (respect for children’s views), and article 23 (support for children with disabilities).

Conclusion

A lack of knowledge of the UNCRC was prevalent in youth from both an urban community and tertiary care hospital, indicating a need for increased dialogue among this community, clinicians, and the healthcare system. These results will also inform patient advocacy communities on gaps in knowledge and access to empower advocacy around child rights.
38 Key to Success to Improve Best Practices: A Nurse Champion to Increase Institutional Use of Procedural Pain and Distress Management Strategies
Authors: Trottier Evelyne D , Laforce Patricia , Paquette Julie , Doré-Bergeron Marie-Joelle , Loemba Sarah , Lacroix Annie , Grou Benedicte
Published: September 2023

Background

Procedural pain and distress management are essential when providing medical care to children. Quality improvement (QI) initiatives need to be developed to improve the knowledge of healthcare providers (HCP), increase their adhesion, and improve care. The Tout doux project is an institutional QI initiative aimed at improving procedural pain management. Since studies have shown that nurse champions are facilitators in implementing best practices, a procedural pain nurse champion (PPNC) was a key part of the Tout doux QI initiative.

Objectives

The aim of this project is to assist HCP in the reduction of children’s procedural pain and distress by increasing their use of procedural pain and distress management strategies with the support of a PPNC.

Design/Methods

For each sector, the PPNC organizes meetings with medical/nursing heads to coordinate and adapt local deployment and helps create a local, multidisciplinary Tout doux committee. Afterward, the PPNC collects data through audits of different procedures, on every shift, to assess the baseline use of pain management strategies. Those results are presented to the local pain committee to determine improvement needs. Then, HCP receive mandatory training through an e-learning module or official lectures to strengthen their knowledge and discuss barriers based on the traditional “4P” approaches to reducing procedural pain: Prevention, Psychological, Physical, and Pharmacological strategies. For 2 months, the PPNC gives field support to the team by providing direct coaching during procedures, helping to guide the local Tout doux committee, and consolidating new HCP knowledge into practice. After this period, audits are completed to evaluate these combined strategies.

Results

Between June 2021 and October 2022, the Tout doux project was deployed in 13 sectors. More than 400 audits were conducted pre-deployment. To date, more than 150-post deployment audits have been realized in 6 sectors. Results show improvement in the use of combined procedural pain and distress management strategies: from 160/234 (68%) of procedures using two or more strategies before the deployment, to 132/150 (89%) of procedures post-deployment (Table 1). To this day, more than 1500 HCP have received training throughout CHUSJ units and clinics.

Conclusion

Deploying the Tout doux project on procedural pain and distress management improved the combined use of coping strategies with the support of a dedicated PPNC. The next step will be to ensure its dissemination throughout the institution and further assess the long-term outcome on patients.
42 Enacting Meaningful Change in the Face of Adversity – Use of a Sentinel Event to Pilot the Creation of a Rapid Response System in a Tertiary Paediatric Care Centre
Authors: Naguib Mariam , Iraqi Hajare , Lehr Anab Rebecca , Rich Catherine , Feder Joshua , Farnesi Biagina-Carla
Published: September 2023

Introduction/Background

Although rare, in-hospital paediatric mortality occurs at a rate of 12.66 per 1000 admissions. Delayed recognition of clinical deterioration is a modifiable factor in such adverse events. In paediatric patients, subtle changes in vital signs often precede acute deterioration and provide an opportunity for early intervention and prevention of further deterioration. Based on this rationale, rapid response systems (RRS), which include a critical care response team (CCRT) and a Paediatric Early Warning Score (PEWS), have been established to facilitate the detection of clinical deterioration and mobilize resources for timely treatment. There is evidence that RRS can significantly decrease inpatient clinical deterioration events and PICU utilization.

Objectives

At our institution, serious patient safety events identified system failures in recognition, communication, and escalation of care in response to clinical deterioration. The root cause analysis led to a quality improvement and patient safety initiative to implement an RRS at our tertiary paediatric care centre.

Design/Methods

Process implementation of this pilot project required consultations with key stakeholders and designation of unit champions to mobilize resources and promote buy-in. Based on other successful implementation strategies, we adopted the Modified Brighton PEWS, defined a response algorithm, created bedside tools, constructed an interdisciplinary CCRT, and organized simulation activities to implement the new process. We used the Plan-Do-Study-Act method to carry out change based on weekly feedback from frontline workers. To assess the feasibility and acceptability of this initiative, all CCRT activations during the pilot phase were reviewed and a survey was distributed pre- and post-implementation. The number of code blues and mortality data will also be measured.

Results

The pilot period spanned June to September 2022 on our medical inpatient unit. Average response time to CCRT activation was 12 minutes (IQR 7-13.5), a median of three therapeutic interventions were required per activation, and 33% of activations resulted in PICU admissions. Among the 27 post–implementation survey respondents, 87% identified CCRT as a useful addition to optimize care and address patient safety concerns. Qualitatively, it has created a shared safety culture and empowered junior members of healthcare teams to escalate care.

Conclusion

This quality improvement initiative pilot study has demonstrated feasibility and acceptability of RRS implementation with a positive impact on patient safety culture and earlier detection and intervention for deteriorating patients. Further prospective comparative clinical benefits and cost-benefit analyses are needed to support hospital-wide implementation.
46 Association of Empiric Antibiotic Selection on Clinical Outcomes in Hospitalized Children with Severe Orbital Infections: A Multicenter Cohort Study
Authors: Nguyen Emily , Mahant Sanjay , Cichon Jessica , Borkhoff Cornelia M , Drouin Olivier , Pound Catherine , Quet Julie , Wahi Gita , Bayliss Ann , Vomiero Gemma , Foulds Jessica , Kanani Ronik , Sakran Mahmoud , Sehgal Anupam , Pullenayegum Eleanor , Widjaja Elysa , Reginald Arun , Wolter Nikolaus E , Parkin Patricia C , Gill Peter J , Krueger Carsten
Published: September 2023

Background

Antibiotic selection in children with periorbital and orbital infections is often empiric and regimens vary widely among institutions in their spectrum and inclusion of anti-anaerobic and anti-staphylococcal agents.

Objectives

Currently, there are no national clinical guidelines for antibiotic selection and no studies comparing commonly used antibiotic regimens in orbital infections. We aimed to determine the association of initial empiric antibiotic regimens with clinical outcomes in children hospitalized with severe orbital infections.

Design/Methods

We conducted a multicentre cohort study of children with severe orbital infections admitted to ten hospitals between January 1, 2009, and December 31, 2018. The association between empiric antibiotic regimen in the first 24 hours of hospitalization with length of stay and surgical intervention were assessed with multivariable median regression and multivariate logistic regression, respectively.

Results

Of 1421 patients, 60.0% were male, and mean age was 6.4 years (SD 4.5). Median length of stay was 86.4 hours (IQR 56.9-137.5) and 180 (12.7%) received surgical intervention. The most frequently (23.6%) administered empiric regimen consisted of a third-generation cephalosporin, anaerobic agent, and staphylococcal agent. After adjustment, broad-spectrum empiric antibiotic regimens with dedicated anti-anaerobic and/or staphylococcal coverage were associated with increased length of stay, ranging from an additional 18.4 hours (95% CI, 6.82, 30.0) to 21.5 hours (95% CI, 11.0, 32.0). Only patients with staphylococcal coverage alone had a statistically significant increased odds of surgical intervention (4.45, 95% CI 1.03, 19.2).

Conclusion

In children hospitalized with severe orbital infections, broad-spectrum therapy with or without coverage for staphylococci and anaerobes were associated with similar clinical outcomes in a clinical setting with low methicillin-resistant Staphylococcus aureus prevalence. Clinical practice guidelines are needed to standardize antibiotic recommendations.
51 Mental Health Trajectories of Children and Caregivers who Accessed School-based Health Centres during the COVID-19 Pandemic
Authors: Rasiah Saisujani , Freeman Sloane , Cohen-Silver Justine , Lebovic Gerald , Xu Keying , Maguire Jonathan
Published: September 2023

Background

School-based health centres (SBHCs) improve health care access for students with mental health concerns, especially for disadvantaged communities who face access barriers. During the pandemic, health care access was restricted; however our SBHCs remained accessible. How SBHCs supported children’s and parents’/caregivers’ mental health during the pandemic is unclear.

Objectives

The primary objective of this study was to compare the trajectory of mental health symptoms in children who used SBHCs during the pandemic compared to those who did not.

Design/Methods

This was a prospective longitudinal cohort study of children who used SBHCs serving disadvantaged children with developmental and mental health conditions. A mental health survey which included the Strengths and Difficulties Questionnaire (SDQ) and the Generalized Anxiety Disorder-7 (GAD-7) was used at three time points during the pandemic for children registered with SBHCs. The primary analysis compared the trajectory of SDQ scores over time between children who accessed the SBHCs during the pandemic and those that did not. The secondary analysis was the same, using the GAD-7 scores for parents/caregivers.

Results

There were 435 children included in the study. The mean age was 10.7 years (SD=3.2). Two hundred and ninety-five children (67.8%) identified as male. One hundred and twenty-eight (29.4%) children had an annual family income of less than $30,000.00. After adjusting for age, gender, and diagnoses, children who attended SBHCs had higher SDQ scores over time relative to children who did not (0.15, 95% CI 0.03 to 0.28, p=0.02). Specifically, the total SDQ score increased by 0.14 (95% CI: 0.02, 0.27; p = 0.03) per month in those who accessed SBHCs during the pandemic, while the change in total SDQ score per month was -0.01 (95% CI: -0.06, 0.03; p = 0.55) in those who did not. Parents of children who attended SBHCs also had higher GAD-7 scores over time (0.16, 95% CI = 0.06 to 0.27, p = 0.002) compared with those whose children did not visit the SBHCs.

Conclusion

Mental health symptoms and anxiety symptoms worsened among children and parents/caregivers who attended a SBHC at least once during the pandemic. SBHCs may have decreased access barriers for children and parents/caregivers with socioeconomic risk factors who experienced mental health symptoms during the pandemic, when other healthcare options were limited. Longitudinal studies with longer follow up would help determine the role of SBHCs in supporting at-risk children and parents/caregivers with mental health needs during the pandemic.
55 Milk Expression Habits in Maternal Milk Donors: Should We Favor Hindmilk Banking for Extremely Preterm Infants?
Authors: Janvier Annie , Girard Melissa , Myhal Geneviève , Chouinard Marie-Claude , Fournier Diane , Lewin Antoine , Renaud Christian
Published: September 2023

Background

A maternal milk bank was established in 2014 in Québec. The caloric contents of pooled milk lots ranges from 58-73 calories/100 ml, whereas most babies need ≥82 calories/100 ml. Hindmilk is 2-3 times fatter than foremilk, contains more protein and would be ideal for the most fragile extremely preterm infants. This would avoid adding cow-milk protein fortifier in the first weeks of life. Hindmilk is only released 2-3 minutes post-letdown, so that the milk expression habits of donating mothers may influence caloric content. These habits are ill-documented, and precise recommendations on milk expression habits are needed.

Objectives

The objective of this study was to examine the feasibility of hindmilk expression by breastmilk donors so as to provide it for the most fragile preterm infants.

Design/Methods

In 2021, an electronic questionnaire was emailed to all active milk donors in Québec to collect data on their milk expression habits and their willingness to change them. The questionnaire contained both closed and open-ended questions. Response were analyzed using mixed methods.

Results

In total, 126 out of 181 donors (70%) completed the questionnaire. Most participants (78%) had a university degree, and 65.0% had >1 pregnancy. Overall, 98% were comfortable or very comfortable with current recommendations on milk expression, and 91% were aware or well aware of the benefits of maternal milk for preterm babies. Concerning breastfeeding habits, 68% reported expressing milk for banking between breastfeedings; 18% reported expressing milk for banking from one breast while keeping the milk from their other breast for their baby; and 14% reported breastfeeding their baby on each breast and keeping hindmilk for banking. Overall, 66% of participants said they would be willing to change their habits most or all the time to provide hindmilk for the most fragile babies. The main theme invoked in open-ended answers was altruism, and gratitude for being able to help others. On the other hand, few participants commented on the complexity of milk expression or reported that additional restrictions might discourage them from donating.

Conclusion

Most participating mothers were already giving foremilk and hindmilk. A significant proportion of respondents said they would agree to change their expression habits in favour of giving hindmilk to be used for only the most fragile infants. More information is needed on how changing recommendations for milk expression might impact the supply and caloric content of mothers’ milk.
58 Predicting and Preparing for the Future: Parents of Extremely Preterm Infants Give Recommendations to Clinicians
Authors: Janvier Annie , Thivierge Émilie , Luu Thuy Mai , Jaworski Magdalena , Pearce Rebecca , Bourque Claude Julie , Synnes Anne
Published: September 2023

Background

Parents of extremely preterm children face many challenges and uncertainties. The information and support provided by clinicians—both before and after birth—is invaluable to help them prepare for the future.

Objectives

To explore the information needs of parents of extremely preterm infants, before birth, in the NICU, and at discharge.

Design/Methods

In 2021, all parents of infants born <29 weeks’ gestational age and seen for neonatal follow-up between the ages of 18 months and 7 years were consecutively recruited over a one-year period in a large academic centre. Parents were asked: “Knowing what you know now, what do you wish doctors would have told you about prematurity before and/or after your child's birth?” Answers were analyzed using mixed methods.

Results

Nearly half (45%) of the 249 parents (98% participation rate) were satisfied with the medical information and support they received, either before or after birth. Prenatally, 16% felt that more practical information was needed in terms of the function of babies born preterm (not only diagnoses), and some parents would have liked prematurity to be mentioned in their normal pregnancy follow-up. 19% of parents wanted to know more about the life trajectory of babies in the NICU, along with knowing what was “the next step”, and how they could be part of the team to help their baby (“What are the different steps during the stay?” and ”How we can help as parents”. 22% wished discharge to be improved, to be better prepared for the future: e.g., “BPD does not help. We would have liked to know what leaving on oxygen meant, that she should not go to daycare, the risk with infections, RSV shots, sleeping problems many preemies have. This could have been done weeks before we left the hospital”. 14% wished they had known more about resources for psychosocial support. Parents (14%) wished clinicians to be more optimistic and provide them with hope: e.g., “Before birth, I would have liked to know that most micro preemies do well”.

Conclusion

Although half the parents were satisfied with the information and support they received, the other half recommended improvements, mainly to make our communication positive and practical. Diagnoses did not help parents prepare for the future prenatally, in the NICU, or at discharge, but information on function and what parents could do to assist (in a practical fashion) did.
61 Antibiotic Resistant Patterns of Bacterial Pathogens Causing Invasive Neonatal Infections in Northern Alberta
Authors: Ting Joseph , Lam Adrien , Tse-Chang Alena , Lee Mao-cheng
Published: September 2023

Background

Antimicrobial resistance is one of the most serious global health threats facing the world today. The neonatal intensive care unit (NICU) is a clinical environment that houses newborn infants who are highly susceptible to overwhelming infection. Early and decisive treatment with powerful anti-microbials tends to be the preferred clinical choice for treating sick infants empirically. Prolonged exposure to antimicrobials can result in multi-drug resistant organisms (MDROs), which can be associated with mortality due to an increase in virulence, delay in appropriate treatment, and a lack of treatment options. An updated antibiogram is important for determining the optimal empirical antimicrobial choice for sepsis evaluations. There is currently a lack of antimicrobial susceptibility data for bacterial pathogens in the Northern Alberta region.

Objectives

The objective of this study is to understand the antibiotic resistance patterns among isolates responsible for bacteremia and meningitis in the NICUs in Northern Alberta through the standard antibiograms produced by microbiology laboratories.

Design/Methods

We conducted a retrospective study to analyze antimicrobial resistance patterns found in NICUs during 2013-2021 in Northern Alberta. Bacteria isolated from blood and cerebrospinal fluid according to commonly used antibiotics in NICUs were collated to create a provincial antibiogram.

Results

A total of 5562 isolates were included in this antibiogram. The most frequently isolated organisms were Escherichia coli (1521), Staphylococcus aureus (1157), members of coagulase-negative staphylococcus (534), Enterococcus faecalis (326), and Klebsiella pneumoniae (357) in neonatal populations. Among the 1157 S. aureus isolates, 24% were resistant to oxacillin (i.e., “methicillin-resistant S. aureus” or MRSA) and 1% were resistant to vancomycin (i.e., “vancomycin-resistant S. aureus” or VRSA). Of the 326 strains of Enterococcus spp., there were no vancomycin-resistant enterococci (VRE) identified. Among gram-negative isolates, 251 out of the 2690 (9.6%) were producing extended-spectrum beta-lactamase (ESBL), in which 52% and 94% were susceptible to gentamicin and amikacin respectively. Among the non-ESBL-producing isolates, E. coli (1521) and K. pneumoniae (357), 7% of the E. coli strains and 1% of the K. pneumoniae strains were resistant to gentamicin.

Conclusion

The provincial antibiogram is a useful clinical tool that can best inform clinicians on the appropriate choice of empirical antimicrobial agent based on commonly identified invasive pathogens in neonatal infections within Northern Alberta. Our findings on these resistant patterns can aid next steps for developing an antimicrobial stewardship program.