bluuebunny/crossref_metadata_2025_split huggingface dataset:
93 Timing and frequency of head ultrasound screening to identify severe neurological injury among very preterm infants
Authors: Patel Sharina , Martel-Bucci Andrea , Wintermark Pia , Shalish Wissam , Claveau Martine , Beltempo Marc 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Universal head ultrasound (HUS) screening for severe neurological injury (SNI) injury is recommended for infants born &lt; 32 weeks’ gestational age (GA). However, the risk of SNI varies inversely with GA at birth and other known risk factors; therefore targeted screening may be more appropriate.

Objectives
The objective of the study is to develop a risk-stratified HUS screening protocol for infants born &lt; 32 weeks’ to identify SNI accurately while minimizing resource use.

Design/Methods
Retrospective cohort study of infants born 23-31 weeks’ admitted to a tertiary NICU between 2011-2017. Patient characteristics were extracted from the Canadian Neonatal Network database. All HUS were individually reviewed by a trained abstractor and grouped based on date of exam relative to birth: ≤ 3 days, 4-7 days, 8-14 days, 28-42 days and 35-42 weeks’ corrected GA. Severe neurological injury was defined as intraventricular hemorrhage grade ≥ 3 and/or periventricular leukomalacia on HUS. Logistic regression models were used to identify perinatal risk factors for SNI and determine the number and timing of HUS with highest diagnostic accuracy.

Results
Of 651 infants included, 72 (11%) developed SNI. Independent risk factors for SNI were GA &lt;29 weeks (AOR 3.09, 95% CI 1.65-6.08), vasopressors (AOR 2.95, 95% CI 1.24-6.80) and mechanical ventilation on day of admission (AOR 2.22, 95% CI 1.23-4.11). Infants were grouped into three screening groups based on their exposure to these risk factors (Table 1). Diagnostic accuracy of 63 models of combinations of HUS time points were assessed, and a screening protocol was developed based on the specific time points of HUS that maximized diagnostic accuracy (area under the ROC curve &gt;0.9) while minimizing number of HUS for each screening group (Table 2). Using this protocol could reduce the total number of HUS performed by 920 (40%) and median number of HUS per infant from three (IQR 2-4) to 2 (IQR 1-2; p &lt; 0 .001).

Conclusion
Implementation of a risk factor-based HUS screening protocol may reduce resource use while maintaining high diagnostic accuracy for SNI, and reflects choosing wisely in the NICU.
106 Understanding the Impact of COVID-19 on Healthcare for Medically-Complex Children and Youth
Authors: Baumbusch Jennifer , Lloyd Jennifer E V , Bennett Shawna 
Published: October 2021

Abstract

Primary Subject area
Complex Care

Background
COVID-19 and associated pandemic measures have disproportionately affected already vulnerable populations, including medically-complex children and youth. In Canada, about one percent of children and youth aged 0 to 18 years (inclusive) are medically complex, which is characterized by having complex, chronic conditions that require specialized care, high healthcare service usage, and functional dependence. In addition to being high users of formal healthcare services, it is estimated that parents spent an average of 52 hours per week providing unpaid care.

Objectives
As part of a larger study exploring the effect of the pandemic on these children and their families, the impact on healthcare usage by this population was investigated.

Design/Methods
In August 2020, a web-based cross-sectional survey was conducted with parents of medically-complex children and youth in British Columbia, Canada. A convenience sample was recruited through posting advertisements on social media platforms, word of mouth, and amplifying the study via the media. The survey, co-created with parent co-researchers, was comprised of 93 questions. It was divided into three sections that focused on pre- and post-pandemic questions about a) medically complex child(ren), b) family/household/community characteristics, and c) respondent demographics. Data were analyzed using descriptive statistics.

Results
Results illustrate the largely negative impact of the pandemic on this population’s healthcare usage. The survey was completed by 156 parents, mainly mothers (92.3%) who reported information for 188 medically complex children and youth. The children ranged in age from 0 to 18 years, with an average age of 9.5 years, and 58.0% were boys. Between February and August 2020, 30.3% of children had visited the emergency department and the same percentage had parents who avoided taking them in circumstances where they typically would have. 36.2% of the children had been admitted to hospital during that period. The children typically saw an average of four medical specialists and during the pandemic 63.8% had a specialist appointment cancelled or postponed by the clinic. During this time, there was also a steep decline or stoppage of all allied health therapies.

Conclusion
These results demonstrate a lack of pandemic preparedness to ensure continuity of services. Consequently, medically complex children and youth may be missing key interventions to address ongoing health issues and maintain functional abilities. More proactive planning and coordination are needed to ensure that future situations will not lead to lack of access or therapy for this vulnerable group.
112 Impact of the COVID-19 pandemic on emergency department visits at a university medical centre
Authors: Mallette Viviane , Cyr Claude 
Published: October 2021

Abstract

Primary Subject area
Emergency Medicine - Paediatric

Background
The new coronavirus, SARS-Cov-2, responsible for a global pandemic, led to the declaration of a health emergency and the implementation of large-scale public health measures by governments in 2020. Those measures, combined with the overlapping symptoms of COVID-19 disease and common viral infections in children, have led hospitals to prepare for possible changes in volume of emergency room visits by children.

Objectives
This study aims to determine the effect of the pandemic and governmental restrictions on the use of the emergency department by pediatric patients at a university medical centre, as well as to assess the impact on the severity of initial presentations.

Design/Methods
A single-centre study was conducted at a university hospital among children aged 0 to 17 who visited the emergency room. We used interrupted time series analysis to compare the average of pre-COVID-19 data (from January 1 2017, to December 31 2019) with data from the first wave of the COVID-19 pandemic (from January 1 to September 2020). Emergency room visits, initial triage codes, and admission and pediatric consultation rates were analyzed to assess whether there was a significant difference between periods.

Results
An important increase in total daily visits (+11.18, 95% CI [6.23-16.14]) was first observed with the emergence of COVID-19 cases in Canada. Then, during the strict confinement, which corresponds to an active period of COVID-19, we detected a significant drop in daily visits (-25.64, 95% CI [-30.4 to -20.66]), which continued while progressively loosening restrictions. The proportion of admissions and pediatric consultations rose slightly only throughout the time of intensive health measures (respectively +4.07% and +3.32%), but no changes in the severity of the triage codes at the emergency department were observed for all periods. Traumatic injuries also saw a significant decrease (p=0.018) when comparing data by groups of diagnosis.

Conclusion
These results show a significantly lower number of children’s visits to the emergency room of a university medical centre, and a transient increase in pediatric care with little impact on the immediate severity of the initial presentations during strict government health measures in the first wave of COVID-19. These measures also had a beneficial effect in reducing the number of traumatic injuries.
120 The Experience of Housing Need Amongst Families Caring for Children with Medical Complexity: A Qualitative Study
Authors: Moore Clara , Hounsell Kara Grace , Zahavi Arielle , Arje Danielle , Weiser Natalie , Esser Kayla , Netten Kathy , Soscia Joanna , Cohen Eyal , Orkin Julia 
Published: October 2021

Abstract

Primary Subject area
Complex Care

Background
Caregivers of children with medical complexity (CMC) face many financial, social and emotional stressors related to their child’s medical condition(s). Previous research has demonstrated that financial stress among this population can have an impact on their housing situation. Families of CMC may face other unique housing challenges such as disability accommodations in the home and housing space and layout.

Objectives
The primary aim of this study was to explore families’ perspectives and experiences of housing need, and its relationship to their child’s health status as it pertains to CMC.

Design/Methods
We conducted a qualitative study using semi-structured interviews to identify themes surrounding families of CMC’s experiences of housing need. Parents of CMC were recruited through purposive sampling from the Complex Care Program at a tertiary pediatric health sciences centre. Recruitment ceased when thematic saturation was reached, as determined by consensus of the research team. Interviews were recorded, transcribed verbatim, coded, and analyzed using thematic analysis.

Results
Twenty parents completed the interview, of whom 89% were mothers and 42% identified a non-English language as their first language. Two major themes and five subthemes (in parentheses) were identified: 1) the impact of health on housing (housing preferences, housing possibilities, housing outcome as a trade-off) and 2) the impact of housing on health (health of the caregiver, health of the child). Some parents reported that their child’s medical needs resulted in specific preferences regarding the location and layout of their home. Parents also indicated that their caregiving role often affected their income and home ownership status, which in turn, affected their housing possibilities. Thus, the housing situation (location and layout of the home) was often the result of a trade-off between the parent’s housing preferences and possibilities.

Conclusion
Housing is a recognized social determinant of health. We found that among CMC, health also appears to be a significant determinant of housing as families reported that the health of their child impacted their housing preferences and the options available to them (possibilities). To support the health of CMC and their families, policies targeting improved access to subsidized housing, improved sources of funding and regulations allowing families who rent to make accessibility changes are vital. Future research should investigate the impact of household income on housing need and identify interventions to support appropriate housing for CMC.
133 Value-based care for healthy children with first episode of febrile neutropenia
Authors: Grandjean-Blanchet Charlotte , Villeneuve Stephanie , Beck Carolyn , Cada Michaela , Rosenfield Daniel , Science Michelle , Fantauzzi Michelle , Butchart Sheila , Ostrow Olivia 
Published: October 2021

Abstract

Primary Subject area
Emergency Medicine - Paediatric

Background
While the management of febrile neutropenia in patients with cancer has clear, evidence-based guidelines, the management of previously healthy, immunocompetent children with a febrile illness and first episode of neutropenia is less understood. These patients are often similarly treated with empiric antibiotics and hospitalization despite studies demonstrating that this population, if they are well-appearing with a short history of neutropenia, is at low risk of serious bacterial infections. Therefore, less aggressive management should be considered in patients meeting low risk criteria.

Objectives
The aim of our quality improvement (QI) study was to decrease the number of unnecessary hospitalizations and empiric antibiotics prescribed by 50% over a 12-month period for otherwise healthy, well appearing patients presenting to the emergency department (ED) with a first episode of febrile neutropenia.

Design/Methods
A team of stakeholders from Hematology, Infectious Disease, Pediatrics and Emergency Medicine was assembled. A review of the literature, peer institutions and local practices of managing febrile neutropenia in healthy children was performed. Using the Model for Improvement, a guideline for the management of healthy children with first episode of febrile neutropenia was developed and refined using PDSA cycles. In January 2020, the guideline was launched for clinical use in the ED. Education, targeted audit and feedback, pathway modifications, and reminders were used to address knowledge gaps and staff turnover. A family of measures was analyzed using run charts and statistical process control (SPC) methods.

Results
Eighteen months of baseline data identified nineteen low risk patients with 84% either hospitalized and/or received antibiotics. It was also uncovered that many patients were misdiagnosed with neutropenia by excluding bands from the absolute neutrophil count (ANC). After the first twelve months of the intervention, sixteen patients met low risk criteria. Hospitalization and/or antibiotics use for this population decreased to 25% and all blood cultures were negative. Recognition of true severe febrile neutropenia also improved. Forty-one patients had a neutrophil count &lt; 0.5, but an ANC &gt; 0.5. Hospitalization and/or antibiotics use for this population decreased from 52% to 10%.

Conclusion
Through a multi-faceted, multidisciplinary QI study, we improved resource stewardship and value-based care by reducing unnecessary hospitalizations and antibiotics in low risk patients with a first episode of febrile neutropenia. Next steps include iterations to the guideline to increase impact along with sustainability planning. This work can easily be adopted by other pediatric and community sites caring for children.
149 Virtual Care: A Quality Improvement Project on the Experience of Paediatricians during the COVID-19 Pandemic
Authors: McCrady Emma , Strychowsky Julie , Woolfson Jessica 
Published: October 2021

Abstract

Primary Subject area
Practice/Office Management

Background
Prior to the COVID-19 pandemic, in-person visits were the standard of care for paediatricians at our centre. With the pandemic onset, virtual care (VC) was adopted at an unprecedented scale and pace. Studies have reported positive patient VC experience; however, few have explored physician experience. This quality improvement (QI) initiative sought to qualify the VC experience of local paediatricians during the pandemic, with the intention of implementing VC clinical practice changes at the department level.

Objectives
To determine key factors that have supported and challenged the adoption of, and that will support integration of, VC in the future.

Design/Methods
The Donabedian model for healthcare QI was used to evaluate VC experience through an online survey with a focus on structure, process, and outcome measures. All physicians affiliated with the Department of Paediatrics (generalists and subspecialists in medicine and surgery) were invited to participate via email. Three reminder emails were sent at 2-week intervals. Descriptive statistics were reported.

Results
The response rate was 32.3% (63 of 195 physicians). The majority of respondents were subspecialists (84.1%), and at academic centres (87.5%) (Table 1). Pre-pandemic, only 30.1% used VC and saw &lt;10% of patients virtually. During March-May 2020, 93.8% transitioned to VC, with &gt; 50% seeing over 75% of patients virtually. By summer 2020, VC use declined, but remained higher than pre-pandemic (53.6% seeing &lt; 25% of patients). OTN and telephone were platforms most used (32.8% and 28.6%, respectively). Most conducted visits from their work location (55.2%) versus home (44.8%).
VC experience was considered positive by most physicians (73.6%), and only 18.8% found VC difficult to use despite technical difficulties reported by 41.5% (Figure 1). Physicians with ≤ 5 years in practice were most likely to find VC convenient (93.8%). Challenges with VC included lack of physical exam, diagnostic uncertainty, lower patient volumes, and poor patient VC etiquette. Regardless of practice location, specialty, years in practice, and prior experience, 96% would continue VC to 25% of patients, ideally for patients who live far away (26.4%) and for follow-ups of patients with established diagnoses (21.4%).

Conclusion
A rapid transition to VC during the COVID-19 pandemic was associated with challenges but also positive experiences. Willingness to continue VC was high. VC experience could be improved with greater patient education and focus on select patient populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for VC at a local level.
The Equilibrium Consequences of Indexing
Authors: Bond Philip , García Diego 
Published: October 2021

Abstract
We develop a benchmark model to study the equilibrium consequences of indexing in a standard rational expectations setting. Individuals incur costs to participate in financial markets, and these costs are lower for individuals who restrict themselves to indexing. A decline in indexing costs directly increases the prevalence of indexing, thereby reducing the price efficiency of the index and augmenting relative price efficiency. In equilibrium, these changes in price efficiency in turn further increase indexing, and raise the welfare of uninformed traders. For well-informed traders, the share of trading gains stemming from market timing increases relative to stock selection trades.
Electronic Transferable Records: A Gap in Qatari Law That Urgently Needs Filling
Authors: Mahasneh Nisreen 
Published: October 2021

Abstract
Qatar has sought to encourage the development of international trade and investment through advancements in its law. In light of the growing importance of electronic operations, it has adopted the United Nations Commission on International Trade Law’s (UNCITRAL) model laws on electronic commerce and electronic signatures. However, they alone are insufficient to respond fully to the present-day needs of international trade. An area in which Qatari law is still wanting is the electronic transfer of records that originated on paper. This article assesses the extent to which current Qatari legislation relating to the assignment of rights, bills of lading, and commercial papers is suited to the transfer of such records by electronic means and identifies aspects on which it falls short. To fill this gap, Qatar should adopt the 2017 UNCITRAL Model Law on Electronic Transferable Records and ensure that it is applied as widely as possible, internally, internationally, and in civil and commercial dealings.
Management of acute lower gastrointestinal bleeding by pharmaco-induced vasospasm embolization therapy
Authors: Li Ming-Feng , Liang Huei-Lung , Chiang Chia-Ling , Lin Yih-Huie 
Published: November 2021

Background:
To report the clinical outcomes of vasospasm embolization technique in treating lower gastrointestinal bleeding (LGIB).

Methods:
Fifty LGIB patients (32 men and 18 women; mean age, 70.4 years) with positive contrast extravasation on multidetector computed tomography were treated with pharmaco-induced vasospasm embolization by semiselective catheterization technique. Distal rectal bleeding was excluded. The bleedings in three patients were considered to be tumor related. Eighteen underwent regular hemodialysis, and 22 showed unstable hemodynamic at intervention.

Results:
Forty-two bleeders were found in superior mesenteric territory and eight in the inferior mesenteric territory. Successful, immediate hemostasis was achieved in 49 (98%) patients. Early recurrent bleeding (<30 days) was found in 13 (26.5%) patients with 6 local rebleeding (12.2%), 5 new-foci bleeding (10.2%), and 2 uncertain foci bleeding (4.1%). Repeated vasospasm embolization therapy was given to five patients, with successful hemostasis in four. All the three tumor-related bleeding patients undergoing vasospasm embolization had ceased bleeding and discharged. Patient-based primary and overall clinical successes were achieved in 73.5% and 83.7%, and lesion-based primary and overall clinical successes were 83.0% and 86.7%, respectively. The 30-day mortality rate was 21.3%, and the 1- and 2-year survival rates were 51.5% and 43.8%. No major procedure-related complications (eg, bowel ischemia) were encountered.

Conclusion:
This study confirmed our prior preliminary conclusion that pharmaco-induced vasospasm embolization is easy, safe, and effective for LGIB. This treatment may be considered the first-line alternative approach for LGIB, especially for patients of advanced age with complex medical problems and/or when vasa rectal embolization isn’t feasible.
O-GlcNAcase inhibitor has protective effects in intracerebral hemorrhage by suppressing the inflammatory response
Authors: He Yating , Liu Haijie , liu Ye , Li Xiaowen , Fan Mengmeng , Shi Kaibin , Li Minshu 
Published: October 2021

Background
Intracerebral hemorrhage (ICH) is aggravated by immune cells that participate in the inflammatory response from the blood–brain barrier (BBB). O-Glycosylation has been reported to regulate the inflammatory response in the central nervous system but its cerebral protective effects remain unknown. Therefore, this study was carried out to investigate the protective effects of O-GlcNAcylation in a murine model of ICH and the possible mechanisms involved.

Methods
The effects of O-GlcNAcylation on hematoma and edema formation were tested using pathological and dry/wet weight methods, whereas its effects on neural function were determined using neurologic tests. The effect of O-GlcNAcylation on BBB integrity was determined by Evans blue dye extrusion. Flow cytometry was used to quantify the immune cells in the central nervous system. Immunofluorescence was used to detect the protective effect of O-GlcNAcylation in ICH.

Results
The hematoma volume was significantly lower in the prevention and treatment groups than in the control group after ICH induction, indicating that O-GlcNAcylation had reduced the formation of cerebral hematoma in ICH. In the prevention and treatment groups, the modified neurological severity score, corner turn test and rotating rod test results were improved and the BBB integrity was better than that in the control group. O-GlcNAcylation also regulated the microglia, neutrophils and other central nervous system immune cells after ICH, effectively reducing the inflammatory response.

Conclusions

O-GlcNAcylation played an important role in suppressing the inflammatory response, enhancing the BBB integrity and reducing edema after ICH.