bluuebunny/crossref_metadata_2025_split huggingface dataset:
9 The Burden of Bronchopulmonary Dysplasia and Pulmonary Vascular Disease in Premature Infants
Authors: de Carvalho Nunes Gabriela , Wutthigate Punnanee , Simoneau Jessica , Renaud Claudia , Dancea Adrian , Beltempo Marc , Altit Gabriel 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Extremely premature infants are at a high risk of bronchopulmonary dysplasia (BPD) and BPD-associated pulmonary hypertension (PH). Prolonged patency of the ductus arteriosus (PDA) may worsen PH; however, due to the lack of evidence supporting improvement in outcomes after strategies to promote ductal closure, our center has adopted a strict non-intervention policy since 2013.

Objectives
Assess PH prevalence and severity, as well as the impact of BPD on echocardiographic parameters of cardiac performance.

Design/Methods
Retrospective cohort of infants &lt;29 weeks gestational age at birth, admitted between 2015 and 2019, and without genetic/congenital anomalies. Measurements from the echocardiography acquired closest to 36 weeks were done by masked experts. Severe BPD was defined as positive pressure support at 36 weeks. PH was defined as an estimated systolic pulmonary pressure (SPAP) ≥40 mmHg or an abnormal septal curvature by eccentricity index (EI) (&gt;1.3).

Results
Out of 387 infants, 222 were included, of which 27 (12%) were categorized as severe BPD and 78 (35%) had PH. Severe BPD was associated with lower birth weight (704±214 vs 842±229g, p&lt;0.01), longer hospitalization (median 138 [IQR 108-167] vs 103 [IQR 86-125] days, p&lt;0.01) and longer mechanical ventilation duration (median 82 [IQR 33-107] vs 17 [IQR 2-32] days, p&lt;0.01), with no difference in gestational age at birth. Severe BPD was associated with PH (70% vs 43%, p&lt;0.01). The combined outcome of death (after the 36 weeks echocardiography) or severe BPD was associated with PH (68% vs 30%, p&lt;0.01), smaller left ventricle length in diastole (2.8±0.5 vs 3.0±0.5 cm, p=0.03), decrease in the tricuspid annular plane systolic excursion (0.7±0.2 vs 0.9±0.2 cm, p&lt;0.01), abnormal EI (1.31±0.25 vs 1.17±0.18, p&lt;0.01) and smaller right ventricle fraction area change (41.3±5.8 vs 47.8±7.6%, p&lt;0.01), without a significant increase on SPAP (35±21 vs 35±14, p=0.15). Other echocardiographic markers were similar.

Conclusion
In the context of a PDA non-intervention policy, a third of our population was affected by PH at 36 weeks. Furthermore, those with severe BPD or death had signs of RV dysfunction (despite similar SPAP estimate), indicating that the effect of BPD on pulmonary vascular remodelling and cardiac function may be underestimated.
15 2020 CaRMS Residency Match Confirms Popularity of Pediatrics
Authors: Rowan-Legg Anne , Zucker Marc 
Published: October 2021

Abstract

Primary Subject area
Medical Education

Background
Longitudinal data about the interest in, and competitiveness of, pediatric postgraduate training in Canada has not been reported.

Objectives
1. To describe the results of the 2020 CaRMS pediatric residency match with respect to application rates, first-choice discipline choices, and succesful match rates by gender. 2. To examine the trend of these indices over the past decade.

Design/Methods
Data from the 2020 Canadian Residency Matching Service (CaRMS) pediatric residency match was evaluated and compared over the past decade. Residency match data from other programs was also used for some comparison reporting.

Results
Of a total pool of 2998 Canadian medical graduate (CMG) applicants in 2020, 305 (10.2%) applied to pediatrics, and 17 of these latter applicants (5.6%) applied solely to pediatrics. In the first iteration CaRMS match, pediatrics was the first-choice discipline for 177 CMG applicants (6.0% of all first choices). Pediatrics has been consistent as a first-choice discipline over the years: 5.9% (2017), 5.5% (2015), and 6.1% (2013). Of the 155 first-year positions offered in pediatrics this year, all were filled.
Of those CMGs who matched to pediatrics in 2020, the specialty was the first-choice discipline for 128 applicants (92.8%) and the second-choice discipline for 9 applicants (6.5%). There were clear gender differences noted. Pediatrics accounted for 8.3% of female and 3.2% of male first-choice disciplines. Of the 135 females whose first-choice discipline was pediatrics, 101 matched to that first choice (74.8%). Of the 41 males whose first-choice discipline was pediatrics, 26 matched to that first choice (63.4%). Since 1995 (at CaRMS’ inception), the rates of first-choice discipline choice by gender have been quite stable (Table 1), with females consistently higher than males, while the first-choice discipline matching rate by gender have varied (Figure 1).
Forty CMG applicants whose first-choice discipline was pediatrics matched to an alternate discipline choice and nine went unmatched, suggesting that pediatrics continues to be a competitive discipline. The pediatric rate of first-choice discipline matching to another alternate choice of 22.6% (40/177) is comparable to Anesthesia (22.1%; 34/154), Ophthalmology (26.7%; 20/75), and Otolaryngology (20.9%; 9/43).

Conclusion
Pediatrics continues to be a top specialty choice for graduates of Canadian medical schools, according to data from the 2020 CaRMS match. There are gender differences noted in the choice of pediatrics as a first-choice discipline, and in the successful match rate to pediatrics programs. The rate of successful first-choice discipline matching by gender have varied over time, with the past two years showing significantly greater matching success for females. These trends in the CaRMS pediatric data have implications on discipline recruitment and the pediatric workforce in Canada, and merit further exploration.
17 Decannulation Following Tracheostomy in Children: A Systematic Review
Authors: Verma Rahul , Mocanu Cora , Shi Jenny , Miller Michael , Chiang Jackie , Wolter Nikolaus , St-Laurent Aaron , Amin Reshma 
Published: October 2021

Abstract

Primary Subject area
Respirology

Background
Despite the large morbidity and potential mortality associated with tracheostomy tube decannulation failure, there are currently no consensus guidelines on pediatric tracheostomy decannulation. This has led to wide practice variation that is largely based on expert option. This is the largest review of pediatric decannulation protocols.

Objectives
To systematically review the literature on existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes.

Design/Methods
Five online databases were searched for relevant studies from database inception to May 29, 2020. Study inclusion was limited to publications that evaluated tracheostomy decannulation in children 18 years of age and younger. Independent reviewers extracted data, including patient demographics and primary indication for tracheostomy. Methods used to assess readiness for decannulation were noted, including the use of bronchoscopy, tracheostomy tube modifications, and gas exchange measurements. After decannulation, details regarding mode of ventilation, location and length of observation period, and clinical outcomes were also collected. Quality assessment of included studies was performed using the Newcastle-Ottawa Scale (NOS) tool. Descriptive statistical analyses were performed.

Results
Twenty-three studies with 1328 children were included (Figure 1). Tracheostomy indications included upper airway obstruction at a well-defined anatomic site (37%), upper airway obstruction not at a well-defined site (13%), and need for long-term ventilation (50%). Bronchoscopy was routinely used in 96% of protocols. Tracheostomy tube modifications in the protocols included capping (83%), downsizing (57%), and fenestrations (9%). Measurements of gas exchange in the protocols included polysomnography (72%), oximetry (61%), blood gases (17%), and capnography with end-tidal CO2 (17%). After tracheostomy decannulation, children in 92% of protocols were transitioned to room air, and 38% of protocols used non-invasive ventilation. Most children (76%) were observed in hospital for 48 hours or less. Of all decannulation attempts, 79% were successful. Overall risk of bias in included studies was low.

Conclusion
The absence of clear evidence-based guidelines in pediatric tracheostomy decannulation has led to large variability in clinical practice. Most protocols include bronchoscopy, tube modifications, gas exchange measurements, and brief hospital admission. Polysomnography plays an integral role in assessing the majority of children for tracheostomy removal. Evidence-based guidelines to standardize pediatric tracheostomy care remain an urgent priority.
23 Pulmonary Hypertension Associated with Bronchopulmonary Dysplasia and Neurodevelopmental Outcomes: A Systematic Review and Meta-Analysis
Authors: Thomas Soumya , Murthy Prashanth , Soraisham Amuchou , Lodha Abhay 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Pulmonary Hypertension (PH) is estimated to occur in 1 in 4 infants with Bronchopulmonary Dysplasia (BPD). The impact of PH in infants with BPD on their neurodevelopmental (ND) outcomes is uncertain.

Objectives
This systematic review aims to evaluate whether PH in infants with BPD is associated with ND delay.

Design/Methods
A systematic literature search was performed to identify studies that reported ND outcomes of infants with BPD (based on NIH definition) and PH (based on echocardiographic findings of PH at 36 weeks PMA). The primary outcome was ND delay in infants with pulmonary hypertension associated with BPD compared with BPD alone. Standardized developmental tests evaluated ND outcomes at 18-24 months corrected age (CA) and three years of age. Quality assessment of the studies was done using the Newcastle-Ottawa Quality Assessment for Cohort studies.

Results
Three retrospective cohort studies met the inclusion criteria. Two studies reported ND outcomes based on Bayley Scales of Infant and Toddler Development-III Edition in cognitive, language, and motor domains at 18-24 months CA (Table 1 and Figure 1). One study reported outcomes at 3 years, including overall developmental delay (Kyoto Scale of Psychological Development [KSPD] scores &lt; 70) and cerebral palsy. The quality of all 3 studies was rated between good, fair, and poor. Pooled data from the 2 studies reporting outcomes at 18-24 months showed no difference between the 2 infant groups for Bayley cognitive score &lt; 85 (Odds ratio [OR]: 3.78; 95% CI 0.87-16.52), Bayley language score &lt; 85 (OR: 1.19; 95% CI0.57-2.49), and Bayley motor score &lt; 85 (OR: 2.04; 95% CI 0.89-4.67). At 3 years of age, children in the BPD-PH group had an increased risk of developmental delay (DQ &lt; 70 in all areas) compared with the BPD group (OR: 4.37; 95% CI 1.16-16.46), but no difference in the risk of cerebral palsy (OR: 0.57; 95%0.03-12.39).

Conclusion
PH in BPD is not associated with a developmental delay compared to BPD alone at 18-24 months CA. However, a single study showed infants in BPD-PH had delayed development at 3 years of age. A large prospective cohort study with longer multidisciplinary follow-up is required to confirm this.
32 Accidental ingestions of cannabis in children pre- and post-legalization: Perspectives from a Canadian paediatric hospital
Authors: Coret Alon , Rowan-Legg Anne 
Published: October 2021

Abstract

Primary Subject area
Public Health and Preventive Medicine

Background
Cannabis is one of the most prevalent recreational substances worldwide. In 2018, Canada legalized the use of recreational cannabis. Cannabis is available in numerous forms, including a wide range of ingestible forms (baked goods, candies, gummies, etc.). This increasing availability and palatability of cannabis – coupled with a rise in the concentration of tetrahydrocannabinol (THC; the psychoactive component of cannabis) in many products – has made children particularly vulnerable. Research has demonstrated rising cases of pediatric accidental cannabis exposures, primarily in U.S. states, but there is a paucity of Canadian data.

Objectives
We sought to: i) Characterize the frequency and clinical features of children presenting with accidental cannabis ingestions to a Canadian tertiary pediatric hospital; and ii) Compare the rates and presentations in the pre- and post-legalization periods.

Design/Methods
A retrospective chart review of Emergency Department visits at the Children’s Hospital of Eastern Ontario (Ottawa, ON) between March 2013 and September 2020 was undertaken, with institutional ethics approval sought. Inclusion criteria were: (i) Age &lt; 13 years; and (ii) Accidental cannabis ingestion, as identified by specific ICD-10 diagnostic codes (T40.7, X42). Data collected from each chart included basic demographics; type and quantity of cannabis ingested; timing and location of ingestion; vital signs and Glasgow Coma Scale (GCS) rating at triage; presenting symptoms; investigations and procedures performed; as well as length of stay in hospital. Data were analyzed using descriptive statistical methods.

Results
A total of 39 patients met inclusion criteria (23 male; 59%). The mean age of presentation was 5.2 years (± 3.3; range 1 month–12 years). The vast majority of visits (32/39; 82%) occurred in the last two years of data collection (i.e., after legalization of recreational cannabis in Canada in October 2018). A total of 15 patients (38%) required admission to hospital, with a mean length of stay of 1.3 (± 1.0) days. Details about each patient’s presenting symptoms, investigations, and disposition were analyzed.

Conclusion
Our data from a Canadian tertiary pediatric centre confirms an increased rate of unintentional cannabis ingestions among young children, particularly post-legalization. This is of significant public health concern. An understanding of the clinical presentation of cannabis intoxication, as well as advocacy for safe storage strategies is prudent for parents, pediatric providers, and public health policymakers.
42 The accuracy and clinical implications of point-of-care testing in children
Authors: Morin Chelsea , Füzéry Anna K , Senthiselvan Ambikaipakan , Gowrishankar Manjula 
Published: October 2021

Abstract

Primary Subject area
Nephrology

Background
Point-of-care testing (POCT) is commonly used at our institution to gather data quickly for sick patients, including electrolytes, glucose, and hemoglobin. Serum electrolytes, hemoglobin, and glucose are the gold standard of testing, but the results often lag POCT by a significant time period. Management decisions are made on the results returned by POCT. Thus, it is imperative to determine the accuracy of POCT at our institution.

Objectives
Determining whether POCT is an accurate and clinically appropriate method to measure electrolytes, glucose, and hemoglobin compared to standard serum testing.

Design/Methods
This study retrospectively reviewed 128 consecutive patients either assessed in the emergency department or admitted prior to November 1, 2019 who had both POCT and serum electrolytes (+/- glucose, hemoglobin, and lactate) performed within 4 hours of each other. A sample size of 128 was required to determine a difference of 3 mmol/L in sodium for an effect size of 0.5, with 0.05 level of significance and 80% statistical power. Patient demographics and additional labs drawn within 4 hours of POCT were extracted. Paired t-tests were used to compare values between serum testing and POCT for each patient. Secondary kappa coefficient analyses were performed to look at agreement within clinically-determined normal ranges. POCT was performed on Radiometer ABL835 FLEX analyzers, and serum testing on Beckman Coulter DxC 800 analyzers.

Results
There were 56 males and 72 females; age range 0.01–17.93 years. There were statistically significant differences between POCT and serum values for all electrolytes and hemoglobin, with POCT over-estimating, but not for glucose (Table 1). Within clinically determined normal ranges, there was substantial agreement between POCT and serum potassium, glucose, and hemoglobin, and fair agreement for sodium and bicarbonate (Table 2).

Conclusion
Our study highlights the importance of verifying abnormal POCT electrolytes and hemoglobin with serum values. Even when POCT values are normal, clinically significant hyponatremia and hypokalemia may not be detected, and when abnormal, hypernatremia and hyperkalemia may be overestimated. In patients with dysnatremia, if diagnosed with serum sodium and monitored with POCT (or vice versa), there is potential for incorrect diagnosis and/or rate of correction with clinical impact. Thus, when following electrolytes and hemoglobin values in a patient, POCT and serum should not be interchanged, and if there is clinical suspicion for these to be abnormal, verification with serum is warranted. Our study is limited to the specific POCT analyzer used, and behaviour of another analyzer may be different.
44 It’s All About That Trach! Using a Modified Delphi Approach to Developing Pediatric Tracheostomy Teaching Tools
Authors: Shah Prachi , Kherani Tamizan , Hicks Elizabeth (Anne) 
Published: October 2021

Abstract

Primary Subject area
Medical Education

Background
Pediatric tracheostomy care is intimidating; regular and emergency care are critical skills. Tracheostomy care training is vital for pediatric patients who have multiple people involved in their care and are fully dependent on their tracheostomy tubes for breathing. An Alberta team is developing an informational tool, the “Tracheostomy Journey”, to help families and health care providers understand and communicate clearly about pediatric tracheostomy. A needs assessment identified consistent, universal, multimodal teaching and communication tools for families, trainees, and hospital and home care providers as a primary need. Consistency in training will also improve communication between caregivers and families.

Objectives
The main objective of this study was to develop shareable pediatric tracheostomy care and management teaching materials for health care professionals and families. The goals of such information are to ensure checks and balances, provide universal, consistent and cohesive teaching content to all caregivers, set expectations, and promote effective communication.

Design/Methods
A modified Delphi approach provided structured development of training modules using existing diverse teaching materials. Participants were asked to focus on safe, consistent pediatric tracheostomy care. Two components were to: 1) Update and consolidate basic hospital discharge checklists for families; 2) Formalize current unstructured emergency training while building new resources to teach families, staff, and trainees through goal-oriented simulations.

Results
We consolidated 7 Home Care tracheostomy care checklists and developed 24 simulations to teach specific care skills, incorporating input from multiple stakeholders to consolidate and unify content. Participants included primary care and subspecialty physicians (Respirology, Otolaryngology, Pediatric and Neonatal Intensive Care), home care, nursing, respiratory therapy, trainees, and families. The teaching materials emphasize inclusive, acceptable skill and confidence-building as well as mastery. Each module includes a scenario, preceptor script, and debriefing materials. Scripting is designed for future video adaptation, to allow review. Pilot evaluation with trainees included knowledge and confidence assessment before and after training, after training specifically addressed the question: “Do they address the goal?”.

Conclusion
Training materials were developed by an expert team via a modified Delphi process and met the intended goals of being accessible, acceptable, inclusive, and effective at teaching and consolidating the skills of those involved in pediatric tracheostomy care. These tools are ready to employ and are anticipated to improve teaching and communication for families and trainees caring for children with tracheostomy.
49 Exploring parental acceptability of universal psychosocial screening in the pediatric emergency department
Authors: Atwal Amanbir , Virk Punit , Wright Bruce , Doan Quynh 
Published: October 2021

Abstract

Primary Subject area
Mental Health

Background
Mental health concerns among children and adolescents presenting to the emergency department (ED) are on the rise. Universal screening can facilitate early identification and management of these concerns, mitigating significant long-term morbidity and mortality. The efficacy of psychosocial screening in the ED is not only determined by accurate identification of concerns, but by downstream resource-seeking behaviours to address these concerns. For many children and adolescents, parents hold a key role in determining their access to care. Thus, parental attitudes and perceptions of psychosocial screening may influence resource-seeking behaviours and predict a youth’s ability to access support.

Objectives
Given the limited understanding of parental perceptions of psychosocial screening in the ED, we aimed to qualitatively explore parents’ attitudes towards screening with MyHEARTSMAP, an electronic self/proxy administered psychosocial screening tool. We also quantified resource-seeking behaviours and explored barriers to seeking care.

Design/Methods
This was a nested qualitative study conducted during the 30-day follow-up period of a larger prospective cohort study. Eligible youth and their accompanying parent/guardian completed a self/proxy psychosocial screen using MyHEARTSMAP. Youth who screened positive were provided with recommendations and resources for support.
30 days (+ 5 days) after their ED visit, parents participated in semi-structured follow-up interviews to share their attitudes, perceptions, and thoughts around the screening and care-seeking process.

Results
Of the 171 participants requiring resources for support, 124 (72.5%; 95% CI 65.2-79.1%) completed the follow-up interview. Most parents endorsed positive perceptions of the screening process, describing it as an “eye-opening” process that “sparked conversation”.74.2% (95% CI 65.6-81.6%) of participants also agreed with the support recommendations they received during their ED visit.
In terms of resource seeking, as displayed in Figure 1, only 41 participants (33.1%; 95% CI 24.9-42.1%) attempted to access support services. Other families felt identified concerns were mild and “not serious enough” to warrant resources, though many expressed an intention to seek care if the concerns escalated.

Conclusion
Parental perceptions of psychosocial screening in the ED were favourable and encouraging, with a majority of participants expressing an understanding and appreciation of the process. This lends support to the implementation of universal psychosocial screening in the ED. Despite positive attitudes towards screening, only a fraction actually attempted to access care. This incongruence may reflect the persisting view that mental health holds low priority and suggests a need for increased education on the importance of seeking timely mental health care.