bluuebunny/crossref_metadata_2025_split huggingface dataset:
81 The Use of Online Care-Maps for Children with Medical Complexity
Authors: Dharmaraj Blossom , Adams Sherri , Beatty Madison , Moore Clara , Desai Arti , Bartlett Leah , Culbert Erin , Cohen Eyal , Stinson Jennifer , Orkin Julia 
Published: October 2021

Abstract

Primary Subject area
Complex Care

Background
Children with medical complexity (CMC) are a highly medicalized population of children who require specialized care across various settings including the hospital, home and community, making care coordination challenging. Care-maps, a visual representation of the people and places involved in a patient’s care, are one such tool to facilitate care coordination (Figure 1). To date, care-maps have not yet been used in a clinical environment, examined in real time or used via a standardized approach.

Objectives
The aims of our study were to develop a shareable standardized online tool that supports the parental creation of a care-map, and to assess the utility of care-maps in clinical care from a parent, health care provider (HCP), and community perspective.

Design/Methods
Parents of CMC were invited to use a standardized online care platform called Connecting2gether for 6-months and create online care-maps that could be shared with their HCPs and other community members (i.e., teachers, secondary caregivers). Demographics and internet usage surveys were completed at baseline and an acceptability survey was completed at 6-months. Surveys were analyzed using descriptive methods and care-maps were analyzed via descriptive visual analysis.

Results
Thirty-seven parents enrolled on the platform and 25 (70%) created a care-map and used it for the duration of the study. Of the 25, 14 (66%) went back and made revisions and 17 (80%) reported using it in clinic, home or school. Visual analysis demonstrated 11 categories (bubbles) that were commonly included. All care-maps included a Medical Team, School/Daycare and Family and Friends category, which automatically populated. The majority of care-maps included a central child bubble with the child’s photo (92%), and Community Medical Services (i.e. rehab centers) (60%). Less frequent categories included Home Care (28%), Goals (16%), and 12% included What I Like, Funding, and Community/Foundation individual bubbles. Some parents reported initial uncertainty, but at end-of-study, some reported care-maps as the most useful feature of the platform. Fifty seven percent (12/23) of HCPs viewed the created care-map and only 20% used it in the child’s care. The majority (83%) of HCPs specifically valued seeing the big picture of the child’s care, found it easy to navigate and the detail it provided.

Conclusion
The ability of care-maps to illustrate the intricate web of medical and non-medical care supporting CMCs in their daily life provides insight and value for parents, HCPs and non-HCPs. Care-maps were found to be valuable from the perspective of HCPs. Parents reported initial uncertainty, highlighting the importance of the HCP promoting the use of care-maps with their patients and families.
85 Exploring reporting of ethno-racial identity and immigration status in published studies on children new to Canada: An integrative scoping review
Authors: Cheung Bonnie , Kaur Pardeep , Suleman Shazeen , Minhas Ripudaman 
Published: October 2021

Abstract

Primary Subject area
Global Child and Youth Health

Background
Children immigrating to Canada may face racism and xenophobia depending on their ethno-racial background and immigration status. In Canada, immigration statuses include economic or family immigrants, resettled government or privately sponsored refugees, or asylum seekers, while some have no formal immigration status, otherwise considered undocumented. Research supporting newcomer child health should account for their immigration status and ethno-racial identity to capture the impact of discrimination.

Objectives
To critically examine the reporting of ethno-racial data and immigration status in published literature on the health needs of newcomer children to Canada.

Design/Methods
An integrative scoping review was performed, using the methodological framework outlined by Arksey & O’Malley. A literature search in Medline, PsycINFO, Scopus, Embase and Cochrane Central for articles published until July 2019 was conducted. Inclusion criteria were original research studies on newcomer children (0-18 years) in Canada in English or French from 2009 onwards. After undergoing title and abstract review, we extracted descriptions of participant immigration status and ethno-racial identity.

Results
4147 articles were identified. After removal of duplicates, 2632 articles underwent title and abstract review, with a kappa-statistic of 0.93, suggesting high inter-rater agreement. Seventy-five studies were included in the final analysis. Overall, there were no consistent descriptions of immigration status or ethno-racial identity. Of the 75 articles included for final analysis, only 27% (20/75) described their participants’ immigration status in some capacity; the majority (75%) of these did not separate out participants by their immigration status (15/20) and of these, 67% combined all types of refugee and economic immigrant statuses together (10/15). With respect to ethno-racial data, the majority of studies (65%, 49/75) did not report on their participants’ ethno-racial identities. Of those that did, 65% (17/26) reported their participants’ ethnicity alone, while only 15% (4/26) reported their race alone and 19% (5/26) reported both race and ethnicity.

Conclusion
Our scoping review demonstrates that many studies focusing on newcomer children to Canada do not consistently collect and analyze their participants’ immigration status or ethno-racial identity. In doing so, studies may falsely conflate the experiences of newcomer children and ignore the impact of racism and xenophobia on their access to care, leading to worsening stigma and access to care. We suggest that research that often informs evidence-based guidelines for newcomer children should consider immigration status and ethno-racial identity to consider the impact of xenophobia and racism and improve health outcomes.
90 Lung ultrasound in pediatric asthma patients: A pilot study characterizing findings at baseline stat
Authors: Marzook Noah , Dubrovsky Alexander 
Published: October 2021

Abstract

Primary Subject area
Emergency Medicine - Paediatric

Background
Unlike the lung ultrasound (LU) findings of pneumonia, bronchiolitis, pleural effusions and pneumothorax, which have all been well described, the sonographic pattern of asthma remains unclear. Previous pediatric studies have shown that pediatric patients with acute asthma exacerbations had positive LU findings. It is also unclear whether these findings were the result of acute infections associated with the exacerbation or if the findings would be present at baseline, outside an exacerbation in an asthmatic patient.

Objectives
The primary objective of this study is to characterize lung ultrasound (LU) findings in stable asthma pediatric patients presenting in a tertiary care asthma or respiratory clinic.

Design/Methods
Eligible patients &gt;6 years of age, underwent a LU by the study sonographer between December 19, 2017 to June 25, 2019, during their regular follow up visit at the pulmonology clinic or scheduled pulmonary function test. Patients were defined as asthmatic if they had a positive methacholine challenge test (MCT) or spirometry at the day of the visit or in the past. Patients were excluded if they had an upper respiratory tract infection in the past 4 weeks, or had any other known pulmonary diseases. Baseline demographic and asthma severity (ISAAC score, ACQ-7) questionnaires were filled out by the patients, following which they underwent a LU by a novice sonographer using a 6-zone protocol. A blinded expert sonographer interpreted the images offline. A positive LU was defined as presence of more than 3 B-lines, consolidation (&lt;1cm or &gt;1cm), absent lung slide, and/or presence of pleural fluid.

Results
Fifty-two patients were enrolled in the study and 19.2% (CI 8.31-30.15) of the asthma patients had positive LU findings. The positive LU findings were diverse including B-lines (80%), small consolidation (80%), pleural line anomalies (10%). Positive LU findings were not correlated to any demographic value.

Conclusion
In our study, 19.2% of asthma patients at baseline have a positive LU. Lung consolidations larger than 1 cm were rarely seen. There were no significant differences between demographic data in asthmatic patients with positive compared to those with negative LUS. This positive LU scan rate is in keeping with a prior study on LU in pediatrics.
97 Decreasing invasive urinary tract infection screening in a paediatric emergency department: A quality improvement initiative
Authors: Paluck Felicia , Kestenbom Inbal , Test Gidon , Ostrow Olivia , Brimmer Brooke 
Published: October 2021

Abstract

Primary Subject area
Emergency Medicine - Paediatric

Background
Fever is a common presentation among children coming to the Emergency Department (ED) and a urinary tract infection (UTI) often needs to be excluded. Sterile techniques, like catheterization, are invasive, can be traumatizing to children, and are time consuming to complete. A two-step approach has been shown to reduce the catheterization rate in febrile, young children without unintended consequences.

Objectives
Our aim was to implement a two-step approach for UTI screening in febrile children 6-24 months in order to decrease unnecessary urine catheterizations by 50% without impacting ED length of stay (LOS) or return visits (RVs).

Design/Methods
After engaging key stakeholders and a nursing champion, we created a process map to understand the current urine collection process in our ED, and areas for targeted improvement. Using the model for improvement, we adopted a 2-step pathway for a suspected UTI in children 6-24 months as our change idea. The pathway involved identifying children who met inclusion criteria for UTI screening, followed by urine bag application and urinalysis (UA) if clinically indicated. Only if the UA was positive, a second urine sample was collected via catheterization, for repeat UA and culture. Through multiple PDSA cycles, our pathway was implemented in the ED along with concurrent staff education. The outcome measure was the rate of ED urine catheterizations. Process measures included the total number of urine cultures sent to microbiology and percent positivity. The balancing measures included ED LOS and RVs.

Results
Since project initiation in July 2019, the ED catheterization rate decreased from 73% to 53% (Figure 1) and the number of urine cultures sent to Microbiology decreased by 23%. The number of urine cultures sent to Microbiology decreased by 23% with a mild improvement in the positivity rate by 2% (Figure 2). There was no significant change in RVs. There was a slight 10-min increase in ED LOS, most likely confounded by the COVID pandemic.

Conclusion
Using improvement methodology, we successfully decreased the number of unnecessary catheterizations in children and the number of urine cultures sent to microbiology. Further refinements to our intervention are ongoing and include optimizing urine screening equipment in patient rooms, poster reminders, re-education for providers, and introducing a parent resource explaining the 2-step pathway. This improvement work is also being spread to the paediatric wards and can easily be adopted by other paediatric centres. It has also been adapted by the Choosing Wisely hospital campaign.
99 Impact of COVID-19 pandemic on children with medical complexity: Parental perspective about the role of a Complex Care program
Authors: Thibault Louis-Philippe , Marano Maria , Saad Lydia , Doré-Bergeron Marie-Joëlle , Couture Karine , Gaucher Nathalie , Bourque Claude-Julie , Kleiber Niina 
Published: October 2021

Abstract

Primary Subject area
Complex Care

Background
The COVID-19 pandemic led to major and rapid organizational and structural healthcare changes including a switch from ambulatory services towards telemedicine and decreased access to home services. Children with medical complexity (CMC) require many medical services and are generally prone to infectious complications. Little is known about the impact of the pandemic on families of CMC. Understanding how CMC families experience the COVID-19 pandemic is essential to tailor healthcare services to answer their needs more effectively.

Objectives
We explored parental experience of CMC during the COVID-19 pandemic, and how the complex care program (CCP) answers their new needs.

Design/Methods
This qualitative study was conducted between July 2020 and January 2021 in a tertiary care pediatric university hospital centre. Semi-structured interviews were done with parents of CMC, admitted in the CCP at least 1 year prior to the beginning of the pandemic. The interview guide was co-constructed by physicians and nurses from the CCP. Interviews were transcribed verbatim and analyzed using NVivo. Data were organized into codes and categories. Thematic content analysis was performed by grouping categories and highlighting emerging themes.

Results
Eleven families (14 parents – 4 fathers, including 3 couples) were interviewed. The first wave of the pandemic seemed to have caused important uncertainty and anxiety amongst parents of CMC. Almost all the parents reported cancelling numerous appointments in order to avoid coming to the hospital at all costs. Some parents, worrying specifically about the fragility of their child, stopped working and stayed home to reduce transmission risks. Fear of facing shortages in medications, nutritional supplements and medical equipment for home care was frequently expressed. They did not express worries about the de-confinement periods. The support provided by the CCP’s staff was greatly appreciated, namely active problem-solving via phone calls, videoconferences, emails and pictures, leading to fewer hospital visits and less need to seek emergency care. Some reported that more general communication from the CCP (e.g., a weekly information email), would have helped to interpret the overwhelming amount of information from the media. Parents expressed a strong desire to maintain telemedicine services after the pandemic.

Conclusion
The COVID-19 pandemic brought additional worries to parents of CMC enrolled in CCPs, including fear of shortages and virus transmission. Direct communication with the CCP and remote problem-solving were greatly appreciated by families. Improvement to follow-up include finding ways to help interpreting data from the media.
104 New Presentations of Anorexia Nervosa and Atypical Anorexia Nervosa In Adolescents During the COVID-19 Pandemic
Authors: Agostino Holly , Burstein Brett 
Published: October 2021

Abstract

Primary Subject area
Adolescent Medicine

Background
The coronavirus (COVID-19) pandemic has had profound effects on adolescent mental health. Beginning in mid-March 2020, public health measures were implemented throughout the province of Quebec, including full school closure and confinement. Previous studies have demonstrated the association between stressful events and the exacerbation of anorexia nervosa (AN), however the association of the COVID-19 pandemic on new AN diagnoses remains unknown.

Objectives
To assess the incidence and severity of newly diagnosed AN or atypical AN (AAN) cases among adolescents during the COVID-19 pandemic compared to the five preceding years.

Design/Methods
We performed a retrospective analysis from Jan 1 2015 to Nov 15 2020 of new eating disorder assessments at an urban tertiary pediatric hospital. Baseline demographic information and clinical assessment variables were collected. The primary outcomes were the incidence of de novo AN or AAN diagnoses and hospitalization within 7 days of diagnosis. Event rate time trends were compared during the period of pandemic public health measures (March 2020 to November 2020) to the proceeding 5-years (January 2015 to February 2020) using an interrupted time series and logistic mixed modeling.

Results
Overall, 353 patients met inclusion criteria during the study period. Median patient age was 15.9 (IQR 13.8-16.9) years, 93% were female, and 65% of patients were diagnosed with atypical AN. For the full cohort at diagnosis, %mBMI was 92% (SD ±15%) and mean weight loss was 11 Kg (SD ±7Kg). In the 5 years preceding the pandemic, there were 4.5 new AN/AAN cases per month with a modest downward trend (ßcoeff=-0.016). During confinement, new diagnoses rose to 8.0/month with a steep upward trend (ßcoeff=1.417, p &lt; 0 .001). Similarly, hospitalizations for new cases increased from 0.8 to 2.6/month with a significant increase in linear tend (ßcoeff -0.012 vs. 0.500, p &lt; 0 .001). Moreover, patients diagnosed during COVID-19 confinement had a shorter duration of symptoms (6 months vs. 10 months, p=0.001), with a higher percentage of body weight loss (19% vs. 16%, p=0.03) at a faster rate (2.3kg/mo vs. 1.5Kg/mo, p=0.001). Bradycardia was more pronounced at diagnosis during the pandemic (55 bpm vs. 62 bpm, p=0.001) with a greater proportion meeting threshold for admission (38% vs. 19%, p=0.001).

Conclusion
During the COVID-19 confinement, new diagnoses of AN and AAN nearly doubled and hospitalizations for these patients more than tripled. Markers for disease severity were more pronounced and evolved more rapidly. Findings highlight the urgent need for increased community resources during the pandemic, as well as prospective research to understand drivers and prognosis for these patients more effectively.
108 Comparing autoimmune encephalitis variants in a pediatric cohort from Hamilton, Ontario
Authors: Grinberg Mark , Schneeweiss Michelle , Povolo Christopher , Inkaran Jeyanth , Jones Kevin 
Published: October 2021

Abstract

Primary Subject area
Neurology

Background
Autoimmune Encephalitis (AE) is an emerging cause of epilepsy with numerous variants, including anti NMDA-receptor encephalitis, for which there is a detectable antibody. However, it is believed that there are many variants of AE for which an antibody has not yet been discovered.

Objectives
This study aimed to determine the differences in disease course of AE patients with and without detectable anti-NMDA receptor antibody.

Design/Methods
This retrospective analysis is part of a Canada-wide project aimed at evaluating the epidemiology and characteristics of AE. Cases with suspected AE were retrieved and screened by two independent reviewers against AE criteria. Those that met criteria were analyzed for trends and stratified into NMDA receptor antibody positive (NMDAr) and negative categories for inter-group analysis. Of 23 cases reviewed, 11 met criteria (aged 1-17 years, 27% males), of which 7 were NMDAr positive.

Results
The NMDAr subgroup was characterized by behavioural changes, focal seizures, and prodromal fever on presentation, whereas the receptor negative subset had a much higher variability of symptoms, without any distinctive patterns. On average, the NMDAr positive group showed an increase in white blood cell count on CSF analysis, and a slight increase in the proportion of patients presenting with supratentorial lesions on MRI. Both groups had abnormal findings on EEG. However, despite the lack of gross differences in findings, all of the NMDAr positive cases received IVIG (most with corticosteroids as well) while only 2 NMDAr negative patients received immunomodulatory therapy. At discharge 6/7 of the NMDAr patients had some form of residual movement disorder while the NMDAr negative group had more variable residual symptoms at discharge.

Conclusion
Our findings show that a high index of suspicion in the diagnosis of AE is required due to the indistinct distribution and variety in its presentation. Negative antibody findings should not rule out AE due to the possibility of unidentified antibodies. Future studies should explore why differences in treatment between the two groups exist, and if slight differences in presentation influence clinical decision-making.
111 The Prevalence of Asthma in Canadian Kindergarten Children and its Association with their Developmental Health: A Population-Level Cross-Sectional Study
Authors: Schneeweiss Michelle , Reid-Westoby Caroline , Hu George , Pottruff Molly , Janus Magdalena 
Published: October 2021

Abstract

Primary Subject area
Epidemiology

Background
Asthma, the most common chronic illness affecting Canadian youth, can profoundly and adversely impact a child’s quality of life. Previous studies have shown a diagnosis of asthma can influence a child’s physical and socio-emotional functioning. Current data on asthma prevalence rates among Canadian children is scarce, and it is still unclear how this diagnosis impacts their development at school entry.

Objectives
The goals of the current study were to 1) examine the prevalence of teacher-reported asthma in Canadian kindergarten children, and 2) investigate the association between asthma and children’s concurrent developmental health.

Design/Methods
A cross sectional, population-level study of kindergarten children diagnosed with asthma as reported on the Early Development Instrument (EDI), was carried out in Canada from 2010-2015. Children’s developmental health in kindergarten was measured with the EDI. This 103-item questionnaire is completed by teachers for their students aged 4-6 years and covers demographic information, as well as five different domains of development. Descriptive statistics were examined for children with and without asthma. The level of statistical significance was adjusted using a Bonferroni correction to account for multiple hypothesis testing. The chi-square and one-way ANOVA statistics, as well as effect sizes (Cramer’s V, and eta squared) were reported for all descriptive analyses.

Results
958 children (0.002% of the final analytical sample) were identified as having a teacher-reported diagnosis of asthma. Compared to their peers, children with asthma were significantly more likely to: be male (68.2% vs 51.2%); have a special needs designation (19.0% vs 3.6%); have a functional impairment (53.5% vs 15.9%); be identified by their teachers as needing further developmental assessment (32.3% vs. 13.1%); and miss, on average, 3 more days of school than their peers (9.44 vs. 6.71). They were also more likely to fall below a vulnerability threshold on one or more of the developmental domains (55.9% vs. 28.8%, Figure 1).

Conclusion
It is likely that the EDI captures only severe cases of asthma, as parents are more likely to disclose their child’s illness to teachers if it may influence their ability to function in a classroom. As such, children with asthma, especially those with severe forms, may require additional support. A partnership in which physicians provide preventative care, and teachers provide academic and classroom assistance, may help to ensure the optimal development of children with asthma, and close gaps between them and their peers.