bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 (&lt;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 &lt; 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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

AbstractBereaved 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

Abstract
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

Abstract:
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

Abstract

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.