bluuebunny/crossref_metadata_2025 huggingface dataset:
55 Profiles of Sleep Problems among Young Children with Autism Spectrum Disorders
Authors: Zwaigenbaum Lonnie , Zaidman-Zait Anat , Duku Eric , Bennett Teresa , Mirenda Pat , Smith Isabel , Szatmari Peter , Vaillancourt Tracy , Waddell Charlotte , Elsabbagh Mayada , Georgiades Stelios , Kerns Connor , Ungar Wendy
Published: August 2020

Background

Sleep problems are more common and severe among children with autism spectrum disorder (ASD) compared to their typically developing peers. The goal of this study was to characterize sleep problems profiles and their clinical correlates, based on a five-factor model of the Children’s Sleep Habits Questionnaire (CSHQ) among preschool children with ASD.

Objectives

(1) To describe empirically-derived patterns (i.e., latent profiles) of sleep problems among young children with ASD; and (2) To examine relations between family cumulative risk and emotional-behavioral dysregulation symptoms and sleep profile membership.

Design/Methods

The study included 318 three-to-five year old children (M= 49.45 months; SD = 5.77). Latent profile analysis was used to identify and describe profiles of sleep problems. Sleep problems were assessed using a previously established CSHQ five-factor model: (1) Bedtime Routine; (2) Sleep Onset & Duration; (3) Night Waking; (4) Morning Waking; and (5) Sleep Disordered Breathing, with higher scores indicating greater problems. We assess whether profile membership was associated with dysregulation difficulties (CBCL 1.5-5) and family cumulative risk index (CRI; constructed based on socioeconomic status, maternal distress, family functioning, and other related factors) using a three-step method (Vermunt & Magidson, 2013).

Results

A five-profile model of children’s sleep problems showed the best fit (Figure 1). Profile 1, Nighttime Sleep Problems (28%), consisted of children with scores around the sample mean, except relatively lower scores on Morning Waking. Profile 2, Severe Sleep Problems (25%), consisted of children with relatively high scores across all sleep problems. Profile 3, Low Sleep Problems (18%), included children with the lowest levels of all sleep problems. Profile 4, Moderate Sleep Problems (17%), included children with all sleep problem levels near the sample mean. Profile 5, Morning Waking Problems (12%), consisted of children with low scores on Bedtime Routine problems but pronounced Morning Waking problems. Dysregulation difficulties (Wald = 13.90; p = .001) and family CRI (Wald = 13.27; p =.001) emerged as significant predictors of profile membership. Higher CRI was associated with higher odds of membership in Profile 2 (Severe Sleep Problems), and lower scores for dysregulation difficulties were associated with higher odds of membership in Profile 3 (Low Sleep Problems).

Conclusion

Children with ASD present distinct profiles of sleep problems that differ, not only by overall severity, but also by relative severity across types of sleep problems. Children’s dysregulation and family risk should be considered in examining children’s sleep.
56 Asking about psychosocial risk factors as part of developmental surveillance: what do parents think about it?
Authors: Plaisance Madeleine , Bourque Claude-Julie , Cousineau Dominique , Chabot Marie-Kim , Valderrama Alena , Lemieux Danièle , Simard Marie-Noelle , Luu Thuy Mai , Gosselin Julie
Published: August 2020

Background

Child development is influenced by the psychosocial environment. As part of developmental surveillance, identifying psychosocial risk factors that could hinder optimal development is therefore important. However, whether parents consider this type of question pertinent and acceptable remains unknown.

Objectives

To examine parental perception regarding the acceptability of asking questions about psychosocial background as part of a standardized developmental surveillance questionnaire.

Design/Methods

Using an online questionnaire and a snowball sampling approach, we surveyed parents living with at least one child <12 years of age over a 6 week-period. They were asked to rank acceptability on a 5-point Likert scale of four psychosocial and two medical indicators related to child development and to justify their answer. Descriptive statistics were computed and qualitative thematic content analysis was done on textual comments.

Results

Of 1651 participants, 97% were mothers and 93% declared having a post-secondary degree. Median age was 34 years old (interquartile range 31-38). An overwhelming majority found acceptable the questions about concerns regarding their child development (99%) and family history of developmental problems (95%). Psychosocial indicators were considered acceptable in the following proportions: substance abuse (84%), food insecurity (77%), past maternal history of depression (74%), and education level (65%). Higher rates of acceptability correlated with higher educational levels. Main themes that emerged regarding unacceptability were as follows: questions being offensive or intrusive, questions not relevant to child development, improper physical environment to ask such questions and lack of relationship with the health care professional in charge.

Conclusion

As part of developmental surveillance, questions on psychosocial risk factors can be disturbing to parents and must be addressed in a trusting environment and with a sensitive manner.
61 Cow’s milk fat and child adiposity: a prospective cohort study
Authors: Vanderhout Shelley , Keown-Stoneman Charles , Birken Catherine , Thorpe Kevin , O’Connor Deborah , Maguire Jonathon
Published: August 2020

Background

International guidelines recommend that children older than 2 years of age consume reduced fat (0.1-2%) instead of whole cow’s milk (3.25% fat) to prevent childhood obesity, but these guidelines are consensus-based and have a low GRADE level of evidence.

Objectives

The primary objective of this study was to evaluate the longitudinal relationship between cow’s milk fat (0.1-3.25%) intake and Body Mass Index z-score (zBMI) in children aged 9 months to 8 years. The secondary objective was to determine the relationship between cow’s milk fat intake and odds of overweight (zBMI >1) and obesity (zBMI > 2).

Design/Methods

A prospective cohort study of children 9 months to 8 years of age was conducted through the TARGet Kids! primary care research network. The primary exposure was cow’s milk fat consumption (skim (0.1%), 1%, 2%, or whole [3.25%]), measured by parental report. The primary outcome was zBMI, an age and sex adjusted measure of child adiposity. Height and weight were measured by trained research assistants and zBMI was determined according to the WHO growth standards. A linear mixed effects model and logistic generalized estimating equations were used to determine the longitudinal association between cow’s milk fat intake and child zBMI.

Results

Among children aged 9 months to 8 years of age (N= 7467), each 1% increase in cow’s milk fat consumed was associated with a 0.05 lower zBMI score (95% CI -0.07 to -0.03, p< 0.0001). Compared to children who consumed reduced fat (0.1-2%) cow’s milk, there was evidence that children who consumed whole cow’s milk had 16% lower odds of overweight (OR=0.84, 95% CI 0.77 to 0.91), p< 0.0001) and 18% lower odds of obesity (OR= 0.82, 95% CI 0.68 to 1.00, p= 0.047).

Conclusion

Guidelines for reduced fat instead of whole cow’s milk during childhood may not be effective in preventing overweight or obesity. Randomized controlled trial data is needed to understand which cow’s milk fat optimizes child growth, development and nutrition.
63 A Needs Assessment of Syrian Refugee Families Regarding a Children & Youth Health Promotion Program in Arabic
Authors: Jaafar Ahmad , Al-Hashemi Eiman , Bahabri Aban , Alrowayshed Mohammed , Hunter Andrea , Canisius Elisabeth
Published: August 2020

Background

Refugee families, particularly children and youth, are considered a vulnerable population. They face many health concerns, including barriers to accessing the healthcare system, which may stem from lack of familiarity with the health care system. Despite the great efforts Canada is putting forward to address newcomer needs, there are limited health promotion efforts directed at Arabic-speaking refugee families, particularly in the wake of the influx of Syrian families since 2015. In fact, there is a lack of well-structured, evidence-based, health promotion program, specifically focusing on Arabic-speaking refugee children and youth.

Objectives

Design/Methods

We took a qualitative approach, in which semi-structured interviews were audio-recorded, transcribed, translated, coded and analyzed using a qualitative framework technique. Six focus groups were conducted, in which a total of 25 Arabic-speaking refugee parents were interviewed by Arabic-speaking interviewers.

Results

Among the 25 participants, 18 reported that they were not aware of existing health promotion presentations in our local area. Moreover, none of the 7 participants who were aware of such presentations have ever attended any. The major reason reported is not being invited to attend. Additionally, of the 25 participants, 24 have expressed their desire of having a child and youth health promotion program in Arabic. Among the most requested topics to be presented include medication coverage and pharmacy access in Canada, first-aid management, dental care, interpretation services, healthy lifestyle, fever measurement and management, prevention of unintentional injuries, navigating the Canadian healthcare system and mental health. Moreover, several factors were described to facilitate the families’ attendance to the health promotion presentations. These include presenting about topics of relevance to the refugee families, having the presentations in Arabic, providing parking spaces, having someone to accompany the families’ children during the presentations, arranging the presentations over the weekend or after 5 pm during the weekdays and holding the presentations in a place close to where the families live.

Conclusion

Arabic-speaking refugee families describe strong interest in attending in-person health promotion sessions in Arabic, focusing on child and youth health, and outline diverse topics of interest.
66 Piloting a respectful challenges workshop in pediatric residency training
Authors: Martin Ashley , Manos Sarah
Published: August 2020

Background

Unaddressed conflict has been shown to negatively impact resident wellness and patient safety, and development of communication and conflict resolution skills are key competencies in medical education. While there are a number of existing communication training programs directed at healthcare providers, these can be costly and difficult to accommodate in an already packed curriculum. We developed a conflict resolution workshop to address local conflict scenarios facing our residents that could be integrated into our program curriculum at no cost.

Objectives

Evaluate resident satisfaction with the addition of a “respectful challenges” workshop to our training program’s academic curriculum.

Design/Methods

We designed a two- hour workshop for pediatric residents at our institution focusing on addressing conflict during residency training. A didactic lecture outlining different approaches was followed by three role-playing scenarios with coaching (conflict with another resident, allied health and faculty). The workshop was facilitated by a senior resident and faculty identified by residents as “approachable”. Residents (PGY1-4) were asked to evaluate the workshop’s content and effectiveness as well as their own comfort addressing conflict using pre and post-surveys with Likert scales. Results of the survey were analyzed using descriptive statistics.

Results

A total of 15 residents were involved in the workshop and completed the pre and post surveys. Eleven were female. Six indicated that they had some form of previous training in conflict management. All residents reported having experienced workplace conflict at least a few times per year, but most said they didn’t always address it (73%). Twelve (80%) thought it was either “quite” or “extremely important” that conflict resolution skills be taught in residency.

All 15 residents felt that the scenarios represented real life and that the format was an appropriate way to discuss conflict in the workplace. The majority of residents felt the workshop helped them better understand their approach to conflict and allowed them to feel better prepared to face challenges in the future (14/15 and 11/15 rated as “quite” or “extremely”). Eighty percent of residents reported that they would feel more comfortable addressing workplace conflict after the workshop.

Conclusion

This concise workshop provided a foundation on conflict resolution for our residents. The use of role play and coaching during simulated scenarios was well received, and residents reported increased comfort approaching workplace conflict in the future. Further evaluation will be important to determine if residents translate these skills into practice.
67 Airway Skills in Paediatrics: Infants are Not Just Little Children
Authors: White Jessica , Rowan-Legg Anne , Chanchlani Rahul , Writer Hilary , Gupta Ronish
Published: August 2020

Background

Airway skills such as intubation and bag-valve-mask ventilation (BVM) have historically been considered necessary skills for all general paediatricians. Recently, evidence has driven practice toward goals of reduced invasive respiratory intervention and support. While patient outcomes have improved, implications include reduced airway skill training opportunities for paediatric residents, and possibly challenges in maintaining proficiency for practicing paediatricians. From postgraduate and continuing professional educational perspectives, the specific airway skill needs for Canadian paediatricians in contemporary practice are unclear.

Objectives

Identify those airway skills that are critical to general paediatric practice in Canada, and whether the skill needs differ by patient age.

Design/Methods

Data on general paediatric procedural practice was collected in 2018 via a one-time survey through the Canadian Paediatric Surveillance Program. A database was created from the 938 collected responses. The survey asked paediatricians to indicate the frequency of performance, opinion of importance, and challenges in maintaining proficiency of various airway procedures. Data was analyzed descriptively, and questions discriminating infant (age < 2y) vs. child (age ≥ 2y) were compared by chi-square or Fisher’s exact test, as appropriate.

Results

In total, 481 (51.3%) respondents worked ≥ 50% in general paediatrics and formed the main analysis group. Responses represented broad ranges of career duration, national geography, and practice settings. BVM of infants was the most commonly performed procedure, with 196 (40.8%) performing this monthly. Infant intubation was performed monthly by 58 (12.1%). A total of 355 (73.8%) and 402 (83.6%) reported never performing laryngeal-mask airway insertion and tracheostomy tube exchange respectively. Both BVM and intubation were performed significantly more frequently in infants than in children (p < 0.001). While many respondents considered BVM and intubation of children as essential skills, significantly more rated performing these skills on infants as essential to their practice (p < 0.001). Of those paediatricians that performed procedures as part of their practice, 68/309 (22.0%) and 192/304 (63.2%) reported difficulty in maintaining proficiency in the skills of infant BVM and intubation respectively.

Conclusion

Although variably utilized, airway skills in infants and children remain a core aspect of practice for many general paediatricians. Specifically, skills related to infants were performed more frequently and were more often rated as essential. Most respondents felt it was challenging to maintain proficiency in several airway skills. Accordingly, airway skills, especially those involving infants, should be emphasized in paediatric residency programs and continuing professional development activities.
76 The predictive validity of MyHEARTSMAP for psychosocial screening in the emergency department
Authors: Atwal Amanbir , Doan Quynh , Wright Bruce , Hankinson Elizabeth , Virk Punit , Azizi Hawmid , Stenstrom Rob , Black Tyler , Gokiert Rebecca , Newton Amanda
Published: August 2020

Background

Mental health concerns in childhood and adolescence are prevalent, affecting nearly one million Canadian youth. In the absence of screening, up to 98% of these concerns can go undiagnosed, leading to significant health, educational, and social consequences. Consequently, the American Academy of Pediatrics recommends the development of screening tools to facilitate early identification and access to treatment.

The Emergency Department (ED) represents a unique environment to implement such universal screening, as it is immediately accessible and may be the only point of contact for some vulnerable youth with undiagnosed illness. However, there are few existing instruments which take into account commonly cited barriers such as time constraints, disruption of ED flow, limited resources, and patient privacy.

Objectives

To facilitate efficient screening with minimal impact on ED flow, our team developed MyHEARTSMAP, an electronic self-administered screening tool. The tool is adapted from HEARTSMAP, a previously validated computerized assessment and management tool used by ED clinicians. MyHEARTSMAP has previously been evaluated for face validity and inter-rater reliability. Here, we measured the sensitivity and specificity of MyHEARTSMAP in identifying mental health concerns in youth.

Design/Methods

A prospective cohort study was conducted at two tertiary care pediatric EDs. Eligible youth aged 10-17 years presenting for a non-mental health complaint were invited to self-screen using MyHEARTSMAP. An accompanying parent/guardian could also complete an assessment of their child. The sensitivity and specificity was measured as the proportion of screened youth with mental health concerns identified through self-assessment by MyHEARTSMAP compared to assessment performed by a clinician (criteron standard).

Results

760 youth and/or parents completed the study intervention. The sensitivity at identifying any psychiatric concerns was comparable between youth and guardian assessments: 92.7% (95%CI: 89.1, 95.4%) and 93.1% (95%CI: 89.5, 95.8%) respectively. The specificity at identifying youth without any psychiatric issues was also comparable between youth and their guardians: 42.2% (95%CI: 37.3, 47.3) and 37.0% (95%CI: 32.2,42.1), respectively.

Conclusion

MyHEARTSMAP is sensitive for identifying youth with mental health concerns. While it showed only modest specificity, false positives were almost entirely (98%) mild issues identified by youth and deemed to be normal by clinicians. This would not place a burdensome demand on mental health services and could be effectively assessed without specialized psychiatric training. Thus, MyHEARTSMAP may be an effective tool for early identification and management of mental health concerns.
77 MANAGEMENT OF PEDIATRIC POST-CONCUSSIVE HEADACHES: A NATIONAL SURVEY OF ABORTIVE THERAPIES USED IN THE EMERGENCY DEPARTMENT
Authors: Lambrinakos-Raymond Kristen , Burstein Brett , Gagnon Isabelle , Zemek Roger , Dubrovsky Alexander Sasha
Published: August 2020

Background

The incidence of children presenting to an Emergency Department (ED) following concussion has increased markedly in recent decades. Headache is the most commonly associated symptom and recent guidelines emphasize the importance of analgesia, yet evidence to inform treatment of post-concussive headache (PCH) is completely lacking.

Objectives

This study sought to characterize abortive therapies used to treat PCH among physicians in academic pediatric EDs and to determine whether duration of symptoms and/or headache intensity influence treatment strategies.

Design/Methods

A scenario-based electronic survey was sent to physician members of the Pediatric Emergency Research Canada (PERC) database. Participants were asked questions regarding management when presented with cases of an adolescent presenting to the ED with PCH refractory to appropriate doses of acetaminophen and ibuprofen. Scenarios differed only by duration of symptoms (48-hours versus 1-month post-injury), as well as headache intensity (moderate versus severe). Descriptive statistics are reported.

Results

Survey response rate was 63% (n/N=137/219). At 48 hours post-injury, 93% of physicians reported that they would initiate treatment for a headache rated as severe. The most commonly selected medications to treat PCH were metoclopramide (72%), an intravenous bolus of normal saline (47%) and non-steroidal anti-inflammatories (NSAIDS; 35%). There was wide variability among second line strategies for refractory pain following first-line treatment. When presented with PTH pain rated moderate in severity, 63% of respondents would change their management compared to severe pain, with 66% no longer offering pharmacologic treatment in the ED and most frequently selecting oral NSAIDS (58%) when electing to initiate treatment. Medication selection was unchanged when presented with a patient reporting severe PCH at 1 month compared to 48-hours post-injury.

Conclusion

Most physicians would treat pediatric PCH in the ED for a patient reporting severe pain, however, pain rated as moderate was less likely to receive abortive treatment. Metoclopramide was the most frequently selected medication for analgesia for severe pain. Future research should aim to establish the efficacy of this and comparative treatments for PTH in children.
82 This is My Child: Piloting and Evaluating a Special Needs Screening Tool for Pediatric Emergency
Authors: Craig William , Kilmer Christopher , Nicholas David , Newton Mandi , Zwaigenbaum Lonnie
Published: August 2020

Background

Parents of children with developmental disabilities (DD) including autism spectrum disorder (ASD) or behavioural conditions can be reluctant to inform the medical team of their child’s diagnosis during a visit to the pediatric Emergency Department (PED). Knowing the child’s sensitivities and needs, however, could make it easier for the healthcare team to provide the best possible care. A one-page tool, “This is My Child”, was developed to bridge this gap.

Objectives

Evaluate the ease of use, benefit to child’s care, and overall acceptance of “This is My Child” from parental and health provider perspectives.

Design/Methods

“This is My Child” was modified from an inpatient tool which helped communication between staff and children with ASD and their families. Developed with input from PED healthcare providers, the tool entailed ten questions pertinent to children who have communication and sensory processing challenges, as well as a prompt for additional comments. Families were recruited in the waiting room, and the study was open to all who were willing to participate. The completed tool was attached to the front of the ED chart prior to the child being seen. At the end of the ED visit, parents and treating healthcare providers completed a questionnaire evaluating the tool. Recruitment was deemed complete once 30 children with a prior diagnosis of a developmental/behavioural condition had been enrolled. Following analysis of the questionnaires, focus groups were held with participating ED healthcare providers.

Results

Of 336 study participants recruited, 199 parents, 225 physicians and 135 nurses returned questionnaires. The large majority of parents, physicians and nurses indicated ‘Strongly or Somewhat Agreed’ that the tool was easy to understand. However, only 18% of physicians and 29% of nurses, yet 76% of parents, felt that the tool should be used for all children seen in the PED. This discrepancy between health care team and parental opinion was explored in the focus groups. Healthcare providers noted that the tool was beneficial in cases where unique developmental needs were reported. Concern was raised given the tool’s perceived lack of relevance for children without special needs, as well as additional staff work for tool utilization.

Conclusion

This easy to use form was welcomed by families, but less so by physicians. Work is ongoing to integrate these perspectives.
98 10 year prospective healthcare data on child maltreatment cases assessed at a tertiary care pediatric centre in Canada
Authors: Boroumand Suzanne , Karwowska Anna , Ward Michelle , Murray Louise , Parker Torrey
Published: August 2020

Background

Child maltreatment is common with a reported prevalence of 32.1%. Physical abuse (PA), sexual abuse (SA), and exposure to intimate partner violence (IPV) are reported by 26%, 10%, and 7.9% of Canadian adults, respectively. While many child maltreatment cases require health evaluation, there is little data on the medical assessment of these cases. The Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2008) reviewed child welfare cases but not data on their medical aspects, despite 5% of substantiated PA cases being sufficiently severe to require need for medical assessment. There is no published data describing the type, breadth, or outcomes of cases seen in the Canadian healthcare system.

Objectives

1 - To describe 10 years of institutional data of children and youth seen for concerns of maltreatment.

2- To use this information to provide recommendations for resource allocation and highlight need for services.

Design/Methods

Secondary data was analyzed using descriptive statistics from a preexisting quality improvement database where information was collected from the CHEO Child and Youth Protection Review Committee (CYP RC) over 10 years (April 2009-April 2019). The project was approved by the CHEO REB.

Results

There were a total of 2651 cases reviewed at the CYP RC. Fifty-seven percent (n=1658) of child maltreatment cases were substantiated. The most common types of substantiated child maltreatment were caregiver capacity 29% (n=481), emotional abuse 19% (n=321), PA 18% (n=304), neglect 16% (n=259), SA 14% (n=227), sexual assault with CYP concerns 2% (n=36), and abandonment 2% (n=30). For PA, soft tissue injuries (e.g., bruising) and fractures were the most common injuries seen in medical evaluations for maltreatment. The most frequently ordered tests are skeletal survey, coagulation screening blood work, and CT head. In SA, most cases of substantiated sexual abuse cases were intra-familial (75%). Most physical examinations in SA cases were normal (83%). Forty one percent (1100/2651) of cases were alerted in the medical record for child protection purposes.

Conclusion

Our findings expand our knowledge of the different types of child maltreatment by linking child welfare and medical assessment information. In cases identified and/or assessed by hospital staff for child maltreatment, 54% were substantiated by child welfare and 41% were “alerted” in the electronic medical record (EMR). The most common type of child maltreatment was “concern for caregiver capacity” which highlights the need for parental education and supports.
101 Screening for Psychosocial Risk in Families of Children with Medical Complexity (CMC)
Authors: Verma Rahul , Mehdian Yasna , Sheth Neel , Netten Kathy , Vinette Jean , Edwards Ashley , Polyviou Joanna , Orkin Julia , Amin Reshma
Published: August 2020

Background

Children with medical complexity (CMC) are defined by their medical fragility, dependence on assistive technology and substantial care needs. Family caregivers of CMC have unique challenges, such as prolonged hospitalizations and poor care coordination, which result in extensive caregiver stress. There is a great need to quantify the level of psychosocial stress and resilience in these caregivers to allow for appropriate allocation of health care resources. The Psychosocial Assessment Tool (PAT) is a brief parent-reported screening tool for measuring psychosocial risk in caregivers of pediatric populations. This is the first study to use the PAT in children with medical complexity.

Objectives

To quantify psychosocial risk in family caregivers of children diagnosed with medical complexity. To identify predictors of caregiver distress based on their sociodemographic factors. It was hypothesized that the extensive health demands of CMC will result in high amounts of chronic, ongoing caregiver distress relative to the previously studied pediatric populations.

Design/Methods

This cross-sectional study was conducted at The Hospital for Sick Children, Toronto, Canada. Family caregivers of children with medical complexity completed the PAT questionnaires during regularly scheduled Long-Term Ventilation and Complex Care clinic visits. Based on the overall PAT scores, caregivers were stratified as “Universal” low risk (<1.0), “Targeted” intermediate risk (1.0 to 1.9), or “Clinical” high risk (≥2.0). Multiple linear regression analysis was performed to examine the effect of sociodemographic variables and illness severity on total PAT scores. Comparisons with previous pediatric studies were made using T-test statistics.

Results

136 [103 females (76%)] family caregivers completed the study. Mean PAT score was 1.17 (SD = 0.740). 61 (44.85%) caregivers were classified as Universal risk, 60 (44.12%) as Targeted risk, and 15 (11.03%) as Clinical risk. Compared to previously studied pediatric populations, our CMC have the second-highest overall PAT scores, which are also substantially weighted towards the higher risk categories (Table 1). Multiple linear regression analysis demonstrated that subjective report of financial hardship by caregivers is a significant predictor of total PAT scores (p < 0.05).

Conclusion

Family caregivers of children with medical complexity report PAT scores amongst the highest of all pediatric populations. These caregivers experience significant psychosocial distress, demonstrated by larger proportions of caregivers in the Targeted and Clinical risk categories. Therefore, psychosocial interventions including financial assistance are urgently needed in this population.
102 Optimizing the Management of Pain and Irritability in Children with Severe Neurological Impairments: A Qualitative Study
Authors: Rizakos Sara , Parmar Arpita , Orkin Julia , Siden Hal
Published: August 2020

Introduction/Background

Pain and irritability of unknown origin (PIUO) is reported to effect 73% of children with severe neurological impairments (SNI), and is a source of stress for children and families alike. Currently, there is no consensus among clinicians on how to manage PIUO and it is often difficult to determine the source of pain. Lacking an explanation for the source leaves clinicians unable to effectively treat the pain and increases a caregiver’s obstacles in providing care. Limited research exists on the effect of PIUO on children with SNI and their families.

Objectives

To explore and characterize the overall experience of PIUO for children with SNI and their families.

Design/Methods

Semi-structured interviews were conducted with parental caregivers of children with SNI who experience PIUO and are followed by the Complex Care Program at SickKids. Interview guide topics included pain expression and management, healthcare-team support and family coping. Interviews were conducted until saturation was reached. Interviews were audio-recorded, transcribed verbatim, coded and analyzed by two independent reviewers using an inductive six-step thematic analysis process on NVivo software.

Results

Fifteen caregivers were interviewed, with 93% being mothers and 33% being a visible minority. Interviews revealed two major themes and associated subthemes (in parentheses): 1) Day-to-day life with PIUO (pain expression and frequency, management, and quality of life) and, 2) Areas for improvement (diagnostic process, resources and support, healthcare-team interactions). Characterizing the PIUO experience is an important area of research as findings can be used to guide clinical teams in providing holistic family-centered care to children with SNI. The findings support the need for clinical innovation by adjusting practice guidelines through the creation and implementation of an integrated clinical pathway to identify treatable causes of pain and irritability in children with SNI.

Conclusion

Diagnostic tests for PIUO are often inconclusive and stressful for patient-families. Limited pharmacological and non-pharmacological treatments exist for PIUO. Parental caregivers describe the experience as emotionally challenging and requested support for coping. Future research should focus on interventions for PIUO in children with SNI and reducing caregiver stress and burden.
110 Improving Asthma Education in the Emergency Department: A Quality Improvement Initiative
Authors: Wohlleben Mikayla , Meleady Laura , Oei Krista , Seaton Claire
Published: August 2020

Introduction/Background

Asthma education and action plans have been shown to improve compliance and symptom control. Provincial guidelines, created in 2015, included asthma action plans, but use of these resources across our site was not consistent.

Objectives

The objectives of this study were to develop and implement an asthma education package, standardize discharge instructions and improve appropriate referrals to Asthma Clinics.

Design/Methods

Using process mapping, staff surveys and patient interviews, we undertook a current state analysis. The resulting change ideas were implemented between October 2018 and January 2020 in 5 PDSA (Plan Do Study Act) cycles, utilizing chart reviews and a standardized data tool to measure outcomes. Rates of repeat Emergency Department (ED) attendances, 2 weeks following the initial encounter and overall rates of ED asthma visits were assessed, using patient medical record data.

Results

Two-hundred-and-twenty-five ED presentations were reviewed, 65.2% (146/224) had a previous diagnosis of asthma. 48.9% (110/225) reported using an inhaled corticosteroid (ICS) at presentation. 89.7% (201/224) had not seen a healthcare provider during this acute illness. Asthma action plan utilization increased from 0% at baseline to an average of 60%, sustained over 2 years. 74.2% (167/225) had an ICS prescribed or advised at discharge. Only 3.8% (8/209) of patients re-presented to an ED within 2 weeks of this asthma visit. 57.3% (129/225) children were referred for ongoing pediatric care: either by a community pediatrician (72.9%; 94/129) or our hospital Asthma Clinic (34.8%; 32/129).

Between 2017 and 2019, there was no significant change in total asthma presentations to our ED/per year (1300, 1395 and 1307, respectively) (Figure 1).

Conclusion

A standardized asthma education package including pre-printed discharge resources, asthma action plans, and a provincially adopted, multi-language education video was successfully implemented into our ED. This demonstrates a multi-disciplinary approach to asthma education that can be utilized across the province. Our data highlights the need for a strong community-based approach for asthma care, and further work is ongoing to assess the efficacy of this education package on medication compliance and recurrent ED visits.
119 Disrupting the cycle of adverse childhood experiences by supporting mothers with addiction
Authors: Gander Sarah , Campbell Sarah , Flood Kathryn
Published: August 2020

Introduction/Background

Adverse childhood experiences (ACEs), including exposure to neglect, abuse and household dysfunction, have been linked to a higher risk of addiction and mental illness. As these children grow up and start families of their own, their children are at higher risk for ACEs. Evidence has shown that interventions targeting high-risk families with young children are most effective at disrupting these cyclic mechanisms, especially where maternal addiction is present.

Objectives

The purpose of this study is to examine the predominance of generational addiction in a cohort of families impacted by maternal addiction, and to identify the potential risks that are present for the current generation of children, in terms of ACEs.

Design/Methods

The Addiction Severity Index (ASI) was administered to women who experienced alcohol- or substance-use disorder during pregnancy. Participants were asked about their family’s history of addiction and if anyone in a given category (i.e. maternal grandmother, mother’s brother) has been affected by either alcohol- or substance-use disorder. Furthermore, existing conditions that are risk factors for ACEs in the current generation were identified (i.e. addiction, incarceration of a family member, domestic violence, mental illness).

Results

Many participants reported that at least one of their maternal (68.9%) or fraternal (42.2%) grandparent was impacted by addiction. The subsequent generation was similarly impacted with most participants reporting the presence of addiction in their father and/or his siblings (88.9%) and their mother and/or her siblings (86.7%) Participants report that they experienced an average of seven ACEs (M = 7.13, SD = 2.501) before their 18th birthday. Of this cohort, 53.35% have been incarcerated at least once, 91.1% have been hit by a sexual partner, and 44.4% have been diagnosed with at least one mental health issue. All participants have personally experienced addiction.

Conclusion

The participants of this study are clients of the Parent-Child Assistance Program (PCAP), a three-year intervention that supports families impacted by maternal addiction. Given the results of the current study, it is evident that growing up in a home where addiction is present increases the risk of ACEs and future addiction and mental health issues. The PCAP intervention is designed to disrupt this cycle and help families to create a healthier family environment.
LOCAL STUDY OF DIAGNOSTIC REFERENCE LEVELS FOR COMPUTED TOMOGRAPHY EXAMINATIONS OF ADULT PATIENTS IN İZMIR, TURKEY
Authors: Yurt Ayşegül , Özsoykal İsmail , Kandemir Recep , Ada Emel
Published: August 2020

Purpose

This study aims to develop local diagnostic reference levels (DRLs) for the most common computed tomography (CT) examinations carried out around Izmir, Turkey.

Methods

Five common CT examinations (head, neck, chest, abdomen–pelvis (AP), chest–abdomen–pelvis (CAP)) from four different radiology centres have been included in the study. CT dose index-volume (CTDIvol) and dose length product (DLP) values were recorded for 50 patients per exam in each centre. Third quartiles of CTDIvol and DLP values were determined as DRLs and compared with international findings.

Results

51.3% of the patients were male and 48.7% were female, with a mean age of 57 (between 18 and 93). DRLs for CTDIvol were recorded as 70, 16, 15, 23 and 16 for head, neck, chest, AP and CAP examinations, respectively, while the corresponding DLPs were 1385, 604, 567, 998 and 1180 mGy.cm.

Conclusion

Results are mostly comparable to the latest international data, except for the head examinations, which were observed to slightly exceed the DRLs established by other countries.
Sensory and Quasi-Sensory Experiences of the Deceased in Bereavement: An Interdisciplinary and Integrative Review
Authors: Kamp Karina Stengaard , Steffen Edith Maria , Alderson-Day Ben , Allen Paul , Austad Anne , Hayes Jacqueline , Larøi Frank , Ratcliffe Matthew , Sabucedo Pablo
Published: August 2020

Bereaved people often report having sensory and quasi-sensory experiences of the deceased (SED), and there is an ongoing debate over whether SED are associated with pathology, such as grief complications. Research into these experiences has been conducted in various disciplines, including psychiatry, psychology, and anthropology, without much crossover. This review brings these areas of research together, drawing on the expertise of an interdisciplinary working group formed as part of the International Consortium for Hallucination Research (ICHR). It examines existing evidence on the phenomenology, associated factors, and impact of SED, including the role of culture, and discusses the main theories on SED and how these phenomena compare with unusual experiences in other contexts. The review concludes that the vast majority of these experiences are benign and that they should be considered in light of their biographical, relational, and sociocultural contexts.
PuMA: A papillomavirus genome annotation tool
Authors: Pace Josh , Youens-Clark Ken , Freeman Cordell , Hurwitz Bonnie , Van Doorslaer Koenraad
Published: August 2020

High-throughput sequencing technologies provide unprecedented power to identify novel viruses from a wide variety of (environmental) samples. The field of ‘viral metagenomics’ has dramatically expanded our understanding of viral diversity. Viral metagenomic approaches imply that many novel viruses will not be described by researchers who are experts on (the genomic organization of) that virus family. We have developed the papillomavirus annotation tool (PuMA) to provide researchers with a convenient and reproducible method to annotate and report novel papillomaviruses. PuMA currently correctly annotates 99% of the papillomavirus genes when benchmarked against the 655 reference genomes in the papillomavirus episteme. Compared to another viral annotation pipeline, PuMA annotates more viral features while being more accurate. To demonstrate its general applicability, we also developed a preliminary version of PuMA that can annotate polyomaviruses. PuMA is available on GitHub (https://github.com/KVD-lab/puma) and through the iMicrobe online environment (https://www.imicrobe.us/#/apps/puma).
Transthyretin amyloidosis
Authors: Laing Craig
Published: August 2020

Cardiac amyloidosis is a poorly understood cause of heart failure and is often undiagnosed. Recent advances in diagnostic testing and understanding of the disease have enhanced the ability of clinicians to detect this disease and provide patients with appropriate treatment. This article shares important information to help clinicians better understand transthyretin amyloidosis, including discussion on pathophysiology, diagnosis, prognosis, and management.
Effects of Benson's relaxation technique on occupational stress in midwives
Authors: Jourabchi Zinat , Satari Elaheh , Mafi Maryam , Ranjkesh Fatemeh
Published: August 2020

Purpose:

To examine the effect of Benson's relaxation technique on occupational stress in midwives working in a Labor and Delivery (L&D) unit.

Methods:

This pre- and post-quasi-experimental study involved 65 midwives with a minimum 1 year of experience using convenience sampling. After training, the participants performed Benson's relaxation technique twice a day for 4 weeks.

Results:

Occupational stress was measured using standard questionnaires of occupational stress. Data were analyzed using the Statistical Package for Social Sciences software. Statistical analysis was performed using the Kolmogorov-Smirnov goodness-of-fit test, Student's t-test, and Wilcoxon signed rank test.

Conclusion:

This study demonstrated that Benson's relaxation technique may be effective in reducing occupational stress among midwives in L&D units.
Conditioned Pain Modulation Efficiency Is Associated With Pain Catastrophizing in Patients With Chronic Low Back Pain
Authors: Christensen Kasper S. , O’Sullivan Kieran , Palsson Thorvaldur S.
Published: August 2020

Background:

Previous studies have found a negative association between a conditioned pain modulation (CPM) response and pain catastrophizing among pain-free individuals. This study investigated the difference in CPM response between individuals with chronic low back pain (CLBP) and pain-free controls, and the association between pain catastrophizing and CPM response.

Methods:

In all, 22 individuals with CLBP and 22 sex-matched and age-matched controls underwent a CPM protocol. Pressure pain thresholds (PPTs) were measured on the lower leg and lower back. The CPM response was registered as the change in PPT from baseline to after a cold pressor test (CPT). Catastrophizing was assessed using the Pain Catastrophizing Scale before the CPM protocol in both groups.

Results:

Analysis of variance showed no interactions in PPT between groups and test sites at baseline or post-CPT. PPT increased significantly after CPT in the control group (P<0.006) but not in the CLBP group. The results showed significantly less pain inhibition participants with among participants with CLBP compared with controls (P<0.04). The CPM response was negatively associated with Pain Catastrophizing Scale scores in the CLBP group (rs=−0.67,P=0.0006) while no association was found in the control group.

Discussion:

This study demonstrated a reduced CPM response and a negative association between pain inhibition and pain catastrophizing in individuals with CLBP. The results suggest that catastrophizing thoughts are associated with the efficiency of descending endogenous pain modulation in CLBP, although a causal relationship cannot be inferred.
Surgical Management of Intramuscular Venous Malformations
Authors: Chen Reuben J. , Vrazas John I. , Penington Anthony J.
Published: August 2020

Background:

Intramuscular venous malformations, often erroneously called “intramuscular hemangiomas,” present to pediatric orthopaedic surgeons either as a differential diagnosis of tumor or as a cause of muscle pain. Treatment options include injection sclerotherapy or surgery. There is some literature to indicate that sclerotherapy can reduce pain, but little evidence on the effectiveness of surgery. The primary aim of this study was to evaluate the efficacy of surgical resection for intramuscular venous malformations, with a secondary aim to evaluate the natural history and presentation of intramuscular venous malformations to improve clinician understanding of this condition.

Methods:

A retrospective chart analysis was performed of cases identified from a vascular anomalies database from January 2004 and December 2018. Primary outcome was change in preoperative and postoperative pain. Natural history of the lesion was assessed, including age when the lesion was first noticed, when it became painful, and when it required treatment.

Results:

Fifty-four cases were identified in the study period of which 40 underwent surgery. Pain improved in 36 of 39 patients (92.3%) who had pain before surgery and 29 (74.4%) were pain free after surgery. All 13 patients who required whole muscle excision to resect the lesion experienced an improvement in pain and 10 (76.9%) were pain free. A history of previous intervention, with surgery or sclerotherapy showed a trend towards less successful surgical outcomes. Patients presented across a wide age range from infancy to adulthood, but the most common presentation was pain with exercise between 9 and 16 years of age, with presence of a mass in about half of cases.

Conclusions:

Surgery, when performed by a surgeon with appropriate experience, is an effective first-line treatment for painful intramuscular venous malformations, offering pain relief in the majority of cases. Magnetic resonance imaging and ultrasound are diagnostic in most cases. The majority of lesions are resectable, meaning they can be removed with a margin leaving a functional limb. Sometimes resection of a whole muscle is required.

Level of Evidence:

Level IV—case series.