bluuebunny/crossref_metadata_2025_split huggingface dataset:
11 “Green Means Go”: Creation of a Discharge Checklist Tool for Patients with Bronchiolitis
Authors: Buba Melanie , Hall Kerry-Lynne 
Published: August 2020

Abstract

Background
A consistent and predictable discharge process is difficult to achieve, yet essential for good patient flow, appropriate resourcing, and safe patient care. At our institution, physicians predicted the estimated discharge date (EDD) for patients with bronchiolitis with 70.5% accuracy (January – March 2019). A key driver of this unpredictability is a lack of consensus on “medical discharge readiness” criteria across providers, which also has impacts on communication within the health care team and with patients and families.

Objectives
1. To improve the ability to predict discharge date for patients with bronchiolitis by implementing a standardized medical discharge criteria checklist tool for one month (April 2019).
2. To more fully engage nurses in their patients’ care by improving transparency and accuracy of information about discharge.
3. To increase patient and family satisfaction with the discharge process.

Design/Methods
Meetings with key stakeholders determined drivers of discharge. Data on national practice variation in the management of patients with bronchiolitis was reviewed and informed the creation of a set of medical discharge criteria. Criteria were reviewed and accepted by the Division of Pediatric Medicine and presented to key stakeholders for feedback. Patient inclusion and exclusion criteria were developed. Feedback on the intervention was sought via surveys to physicians, nurses and patients/families.

Results
There was significant improvement (70.5% to 92.3%) in accuracy of predicting EDD with use of the medical discharge criteria checklist tool. There was also a reduction in length of stay. There were no patient bounce-backs to ED or patient readmissions. There was high satisfaction and support of the checklist tool from nursing and caregivers.

Conclusion
The development of standardized medical discharge criteria for patients with bronchiolitis is a safe and effective way to improve predictability, transparency, communication and patient flow, while enhancing engagement of the health care team and patient and family satisfaction. Its use is also associated with a reduced length of stay. Future directions include integrating the checklist tool into the electronic health record and moving towards a nurse-facilitated discharge process. Exploring and addressing non-medical barriers to discharge should also be a priority.
13 Evaluating Potential Overuse of Intravenous Hydration in Patients Hospitalized with Bronchiolitis
Authors: Langlois Vénitia , Sainte-Marie-Lestage Chloé , Bernard-Bonnin Anne-Claude , Lucas Nathalie , Bédard Pascal , Essouri Sandrine , Evangeliou Helena 
Published: August 2020

Abstract

Background
Bronchiolitis is the primary cause of hospitalization in children during the first year of life. Respiratory support and hydration are the two pillars of management. Practice guidelines for bronchiolitis (NICE and CPS) recommend nasogastric (NG) hydration before intravenous (IV) fluids if oral hydration cannot be maintained. However, IV hydration remains the primary mode of hydration at our tertiary care pediatric centre.

Objectives
This is a resource stewardship project aiming to evaluate the baseline use of IV versus NG hydration in children 0-15 months hospitalized for bronchiolitis and requiring supplemental hydration. The secondary objective is to evaluate potential barriers to NG hydration for these children.

Design/Methods
Data was collected retrospectively for the 2017-2018 bronchiolitis season. A survey was sent to all the pediatric emergency (ED) physicians and nurses, pediatric hospitalists, ED fellows, pediatric residents and ward nurses.

Results
Among eligible patients (n=95), IV hydration was prescribed 52% of the time, compared to 48% NG hydration. Ninety-six percent (47/49) of IV hydration was initiated in the ED, while only 4% (2/49) was initiated on the ward. Among patients who began receiving hydration in the ED (80/95, or 84%), 41% (33/80) were hydrated via NG and 59% (47/80) by IV.
In the survey, while 92% (57/62) of responding physicians claimed to be aware of national guidelines for bronchiolitis, only 67% (42/62) said that NG was the recommended mode of hydration. Among ED practitioners, 56% (19/34) were up-to-date on the recommendation. Two-thirds of all respondents (physicians and nurses) felt that NG hydration would be more acceptable to parents. Among nurses, 84% (38/45) felt that IV installation was a longer procedure to complete. Despite the existence of a local order set indicating NG hydration as the preferred hydration method, only 64% (40/62) of physicians were aware of its existence, and only 23% of these (9/40) actually use the guideline. Main reasons of disuse included forgetting the guideline exists and it not being easily available. In contrast, 93% of nurses were aware of the local guideline.

Conclusion
Intravenous hydration is overused among patients hospitalized with bronchiolitis at our centre, and the ED is the main setting where this occurs. There is a discrepancy between physicians’ theoretical knowledge of hydration guidelines and the application of these in reality. Barriers to the use of NG hydration can be amenable to a quality improvement (QI) intervention targeting improved knowledge and use of our local guideline, and this will be our focus going forward.
15 PAEDIATRIC TUBERCULOSIS MANAGED AT A CANADIAN CHILDRENS HOSPITAL: RELATIONSHIP TO BIRTHPLACE AND TRAVEL HISTORY
Authors: Elhafid Melanie , Morris Shaun , Kourdi Haifa , Waters Valerie , Lam Ray , Kitai Ian 
Published: August 2020

Abstract

Background
There are limited data about the relationship of child’s birthplace, parents’ birthplace, and travel history to paediatric tuberculosis (TB) acquisition and disease phenotype in Canada. Travel history is not routinely collected by public health authorities for cases of TB in Canada.

Objectives
The objective of this study is to investigate the association of paediatric TB acquisition and disease phenotype at a metropolitan Canadian children’s hospital with child’s birthplace, parents’ birth place, and travel history.

Design/Methods
We reviewed prospectively collected TB clinic data (which include travel histories) and records of patients aged 0-17 years managed for active TB disease at a children’s hospital ambulatory TB clinic between January 1, 2002 and December 31, 2018.

Results
Two hundred and twenty six cases were identified, of which 116 (51%) were Canadian-born and 110 (49%) were foreign born children. Of the Canadian-born cases, only one case had parents who were both Canadian-born. In comparison to foreign-born patients, Canadian-born patients were more likely to have a history of travel to a TB-endemic country (63/104) [61%] versus (25/103) [24%], odds ratio [OR] 4.8; 95% confidence interval [CI] 2.6-8.7 p&lt;0.001. Canadian-born patients were also more likely to have a known index case (80/116) [69%] versus foreign-born patients (23/110) [21%], OR 8.4; 95% CI 4.5-15.4, p&lt;0.001. For Canadian-born patients, those without a known index case were more likely to have a history of travel to a TB-endemic country than those with a known index case (28/34) [82%] versus (35/70) [50%], [OR] 4.7 95% CI 1.7-12.7, p=0.02. Compared to Canadian-born patients, foreign-born patients had more extrapulmonary disease (48/109) [44%] versus (19/114) [17%], OR 3.9; 95% CI 2.1-7.3, p &lt;0.001.

Conclusion
Canadian-born children often acquired TB through contact with an infectious source in Canada. However, travel was likely important in a significant minority of cases, especially in Canadian-born children without a known index case. Post-immigration travel may also have been the source of TB in some foreign-born individuals. This would reduce the effectiveness of screening children for TB infection upon immigration. Strategies to prevent and detect travel-related TB are needed to reduce paediatric TB in areas with high immigration rates.
18 Lyme disease as an emerging cause of Seventh Cranial Nerve Palsy (“Bell’s palsy”) in Nova Scotia
Authors: LeBlanc Julia , Young Michael , Wood Ellen , MacKinnon-Cameron Donna , Langley Joanne 
Published: August 2020

Abstract

Introduction/Background
Lyme disease, a tick-borne zoonosis caused by the bacterium Borrelia burgdorferi, has emerged in Nova Scotia (NS) as a common illness. Since 2002 when Lyme disease was first diagnosed in NS, &gt;1000 cases have been reported. Seventh cranial nerve palsy (CNP-7) is said to be the most common presentation of early disseminated Lyme disease in children in endemic areas.

Objectives
We aimed to determine the frequency of CNP-7 in NS and if physicians are considering Lyme disease as an etiology.

Design/Methods
A retrospective review of health records of children seen at the IWK Health Centre from 2000-2018 who were ≤18 years of age with an ICD-9 or 10 diagnosis of Bell’s palsy (CNP-7) was conducted. CNP-7 due to local infection, trauma, malignancy, or systemic neurologic disease was excluded.

Results
Of 237 ICD “Bell’s palsy” diagnoses, 66 cases were eligible, of which 60.6 % (n=40) were female. The median age was 10 years (range 0-16). Five cases of Lyme disease-associated CNP-7 were recognized (7.6%), all since 2013. No bilateral CNP-7 occurred; 59.1% of cases were on the left. Most children presented within 3 days of symptom onset (84.8%) to the emergency department (95.4%), and 56.1% subsequently saw a pediatric neurologist. The most common associated symptom with CNP-7 was headache (22.7%). Lyme disease was considered in the differential diagnosis in 34.8 % (n=23) of cases, and only since 2012. Systemic steroids were prescribed to 51.5 % (34/66) of children in the emergency department, for durations varying from 1 to 10 days. The most common steroid course length was 5 days. Antimicrobials were prescribed for 18 (27.3%) children including acyclovir, beta lactams and tetracyclines.
Resolution of the facial palsy findings was documented in 45 children, of whom 36 (54.5%) had complete resolution and 9 (13.6%) had partial resolution. Four children with Lyme disease associated CNP-7 had complete resolution, and one had partial resolution.

Conclusion
There does not appear to be a standard approach to diagnosis and management of CNP-7 in this pediatric health centre. Lyme disease is not regularly considered in the differential diagnosis, which is surprising given the high incidence of Lyme disease in NS. These findings will be shared with health care providers most likely to see CNP-7 in order to develop a standard algorithm to the initial presentation of 7th cranial nerve palsy in children.
22 Parental Perceptions and Patterns of Cannabis Use During Pregnancy and Breastfeeding at a Canadian Tertiary Obstetrics Centre
Authors: Manning Sarah , Drover Anne 
Published: August 2020

Abstract

Background
On October 17th, 2018, recreational cannabis use became legalized in Canada. Tetrahydrocannabinol (THC) is the main psychoactive compound in cannabis. It has the ability to cross the placenta and enter fetal tissues during pregnancy and accumulate in breast milk postpartum. There is limited research on the long-term effects of cannabis use, particularly on the developing brain. Canadian guidelines recommend that women who are thinking about becoming pregnant, are pregnant, or breastfeeding should abstain from using cannabis.

Objectives
The objective of this study was to investigate parental perceptions and patterns of cannabis use during the pre- and post-natal periods.

Design/Methods
Participants were recruited from the women’s health unit at a tertiary care centre; a total of 102 patients or partners of patients who were currently pregnant or less than 6 months post-partum were enrolled in the study. Participants consented to complete an anonymous, online questionnaire including previously validated demographic questions and newly developed questions on cannabis use during pregnancy and breastfeeding. Chi-square tests were used for data analysis.

Results
Overall, 5.0% of pregnant women and 6.3% of breastfeeding women used cannabis daily or weekly. Women who did not complete high school were significantly more likely to use cannabis during pregnancy than women who completed higher levels of education (p &lt; 0.001). Additionally, women who smoked cigarettes or vaped tobacco during pregnancy were significantly more likely to use cannabis during pregnancy (p &lt; 0.001; p &lt; 0.001). Among all participants, 22.6% and 30.4% believed there was no harm or were unsure of the harm associated with cannabis use during pregnancy and breastfeeding, respectively. Around half of the women who used cannabis during pregnancy or breastfeeding indicated that knowledge of the possible effects on the fetus or child would decrease their cannabis use. The majority of participants reported obtaining their information on cannabis use during breastfeeding from the internet (34.0%); while only 8.1% reported receiving information from a family doctor, 6.5% from an OBGYN, and 1.6% from a pediatrician. Legalization of cannabis had no reported effect on cannabis use during pregnancy and breastfeeding for the majority of participants.

Conclusion
It is clear that parents lack information about the safety of cannabis use during pregnancy and breastfeeding. Perinatal counselling should put an emphasis on educating parents on the risks associated with cannabis use during fetal development. In addition, given the overwhelming benefits of breastfeeding, harm reduction approaches to cannabis use while breastfeeding should be investigated.
30 Predicting gestational age improves newborn screening for congenital adrenal hyperplasia
Authors: Jomaa Danny , Henderson Matthew , Hawken Steven , Chakraborty Pranesh 
Published: August 2020

Abstract

Background
Newborn screening for congenital adrenal hyperplasia is performed using a two-tier approach. The first tier involves comparison of neonate 17-hydroxyprogesterone levels to gestational age (GA)-based thresholds. When GA is unreported, which occurs in approximately 5% of births, birth weight (BW)-based thresholds are the only available option. However, these have a lower specificity and result in more false positive results. Recently, a predictive model was developed to estimate GA based on newborn demographics and the screening analytes measured in a blood sample.

Objectives
The objective of this study was to determine whether supplying a predicted GA to newborns with unreported GA, and subsequent GA-based screening, has a higher positive predictive value than BW-based screening.

Design/Methods
Screening data was obtained for approximately 700,000 births that occurred in Canada between 2011 and 2015. Predicted GA was calculated using a model composed of demographic and screening analyte factors. The positive predictive values of BW- and predicted GA-based screening were calculated for newborns with unreported GA. A sequential approach was then developed whereby newborns with unreported GA were first screened by BW-based screening. Newborns that screened positive were then supplied with their predicted GA and screened using GA-based thresholds.

Results
First-tier CAH screening using GA-based 17-hydroxyprogesterone thresholds had a higher positive predictive value than using BW-based thresholds (1.30% vs. 0.82%). In the study time period, 3.61% of newborns had an unreported GA. For these newborns, predicted GA-based screening had a higher positive predictive value than BW-based screening (0.83% vs. 0.76%) and correctly identified the 2 infants with CAH whose GA was unreported. A sequential screening approach was then used: BW-based screening and, for the screen positive population, predicted GA-based screening. This further increased the positive predictive value compared to BW-based screening (0.95% vs. 0.76%), reduced the false positive rate, and correctly identified true positive cases.

Conclusion
Reducing the false positive rate of CAH screening is important to prevent unnecessary second-tier screening and referrals. For newborns with unreported GA (4-5% of all births), BW-based screening is the only currently available approach. However, this approach has a poor specificity and a high false positive rate compared to GA-based screening. This study is the first to demonstrate an alternative screening strategy with a higher positive predictive value for newborns with unreported GA.
45 Helping the Helpers: Peer Critical Incident Stress Management for NICU Health Care Providers to Improve Resilience, Burnout and Patient Safety
Authors: Lifeso Natasha , Hicks Matthew , Joynt Chloe 
Published: August 2020

Abstract

Introduction/Background
Health care providers in neonatal intensive care units (NICU) experience critical or distressing events that can overwhelm their usual coping skills and lead to significant stress. Ineffective support for health care providers dealing with critical incidents can lead to poor unit resilience, staff burnout and compromised patient care behaviours. A formalized peer program and process to address critical workplace incidents and support care providers, “Critical Incident Stress Management (CISM)” is used in many first responder professions. While there is growing interest in implementing peer CISM teams in critical care units, there is a lack of research describing the impact of CISM in NICU.

Objectives
This study examined the effect of implementing a multidisciplinary NICU health care provider peer CISM team on resilience, burnout, and team/safety culture in a tertiary NICU.

Design/Methods
Multidisciplinary team members were peer selected and formally CISM trained. Change management strategies were employed to introduce CISM to the NICU. All health care providers were invited to complete an anonymous online or paper survey before and 1 year after NICU CISM team implementation. The survey contained validated measures of resilience, burnout, and team/safety culture that were analyzed pre and post intervention.

Results
The response rate pre-intervention was 66% (114/172 staff) and 32% post (60/186 staff). Stress recognition significantly improved as fewer staff reported being less effective at work when feeling stressed post incident (74% vs 61%, pre and post CISM respectively, p&lt;0.05) (Table 1). Fewer staff reported feeling burned out from their work (41% vs 31%, p=0.4), trending towards improved resilience (Table 1). Communication in the NICU significantly improved as staff indicated debriefing methods met their needs (38% vs 57%, p&lt;0.05) and felt comfortable speaking up about safety concerns (66% vs 78%) (Table 1). Post-intervention, despite feelings of increased workload indicated by a significant decrease in agreement that “NICU staff levels were sufficient for patient load” (54% vs 33%, p&lt;0.001), a majority of staff reported a supportive environment in the NICU (59% vs 77%, p=0.08) (Table 1). Work culture significantly improved as staff felt rewarded and recognized for improving quality (13% vs 31%, p&lt;0.05) (Table 1).

Conclusion
Implementation of a peer CISM team led to improved NICU care provider resilience, stress recognition, and team culture, all of which can mitigate the effects of increased patient load. Findings from this research and knowledge gained from the CISM implementation process should be shared with other health care environments.
50 Bridging the gap between education and health: What youth need educators to know about chronic pain
Authors: McMahon Casey , Bonkowski Rylie , Hoehn Marty , Baerg Krista 
Published: August 2020

Abstract

Background
Chronic pain is common and affects 20% of children and youth. Those with chronic pain often have a difficult time regularly attending school, with up to 50% of children and youth with chronic pain missing some school. Specific accommodations that benefit youth are unknown. Nearly half of parents of youth with chronic pain report their child’s grades dropped since pain onset. Both parents and youth report “moderate levels of interference” with learning. Most common accommodations include being sent to the nurse, being sent home and receiving extensions on assignments. While these strategies may be helpful for pain conditions expected to resolve, strategies that support staying in and succeeding at school are required for youth with chronic pain.

Objectives
This study aims to determine what educators need to know to best support youth with chronic pain in the academic setting. More specifically, 1) to determine what youth with chronic pain, parents of youth, educators, and healthcare professionals want educators to know about supporting students with chronic pain, and 2) to describe health professionals’ and educators’ attitudes and knowledge of pediatric chronic pain.

Design/Methods
Inclusion criteria include youth age 12-25 years with chronic pain and parents, health professionals and educators of youth with chronic pain. The recruitment strategy includes distribution of the survey via the Saskatchewan pediatric chronic pain clinic research contact lists, the Canadian Paediatric Society Section of Community Paediatrics listserve and social media. This online cross-sectional survey includes participant demographics and questions about accommodations noted to be helpful for youth with chronic pain. In addition, educator and health professional surveys include the 26-item Chronic Pain Myth Scale (CPMS).

Results
The study group includes 87 participants, 26 youth, 18 family/friends, 19 educators, and 24 health professionals. Some suggested school accommodations include: access to technology in class, teachers providing notes for students, education on chronic pain for teachers and students, and improved communication and collaboration between the youth, their healthcare team and educators. The majority of health professionals and educators report some knowledge, positive beliefs and attitudes towards people suffering from chronic pain (M=3.03, SD= .34).

Conclusion
Chronic pain is common and affects school attendance and achievement. Suggestions for accommodations to help those with chronic pain in the academic setting are made. Educators and health professionals indicated varying levels of knowledge, attitudes and beliefs, with some educators indicating they would like to receive education about chronic pain. Improved communication between school-based pupil support teams and health care teams is warranted.