bluuebunny/crossref_metadata_2025_split huggingface dataset:
31 Noninvasive high-frequency oscillatory ventilation in preterm infants: Safe and effective
Authors: Soucy-Giguère Laurence , Drolet Christine , Piedboeuf Bruno , Hébert Audrey 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Mechanical ventilation is frequently used in preterm infants for various indications, but is associated with multiple complications, including bronchopulmonary dysplasia and poorer neurodevelopmental outcomes. Noninvasive high-frequency oscillatory ventilation (nHFOV) is a noninvasive ventilation (NIV) strategy used to avoid mechanical ventilation and associated complications. However, its effectiveness remains controversial, and its safety has not been established.

Objectives
The objectives were to evaluate the effectiveness of nHFOV to prevent intubations and support adequate ventilation in preterm infants, and to assess its safety profile.

Design/Methods
This was a retrospective crossover case study including 24 infants and 30 nHFOV instances between May 2018 and June 2020. Infants were included if they were placed on nHFOV for at least one hour; each nHFOV trial contributed as one instance. Data was collected from health records. Effectiveness outcomes were: successful transition to another NIV mode without requiring intubation, and variations in CO2, FiO2, and number of spells. Safety outcomes were: apparition of intraventricular hemorrhage (IVH), gastrointestinal complications, nasal cutaneous trauma, and comfort as assessed with the Neonatal Pain, Agitation and Sedation Scale (N-PASS). Descriptive statistics were used for baseline characteristics. Nonparametric and semiparametric tests were used to compare outcomes pre- and during nHFOV.

Results
Baseline characteristics are presented in Table 1. At initiation of nHFOV, mean chronological age and weight were 24 days (95% CI: 20 – 28) and 1119 grams (95% CI: 1038 – 1200) respectively. The most frequent indication for nHFOV was spells (56.7%), and the mean duration of nHFOV instances was 3.9 days (95% CI: 2.7 – 5.1) (Table 1). In 18 (60%) cases, infants transitioned successfully to another NIV mode without requiring intubation. Levels of CO2 and number of spells were significantly lower during nHFOV than pre-nHFOV. There was no significant difference in FiO2 pre-nHFOV and during nHFOV. No apparition or progression of IVH was observed following the use of nHFOV. There was no significant difference in N-PASS, nasal trauma, and gastrointestinal complications pre-nHFOV and during nHFOV (Table 2).

Conclusion
This study suggests that nHFOV is an effective ventilation method to avoid intubation and to decrease spells in preterm infants, without increasing complications.
34 Improving workflow efficiency by implementing priority indication in paging communication
Authors: Lee Jimin , Desai Tejas , Horwitz Jennifer , McLean Connor , Nelson Matthew , Seidman Gillian , Buba Melanie 
Published: October 2021

Abstract

Primary Subject area
Hospital Paediatrics

Background
Paging is an important method of communication in hospitals but can also interrupt clinical care unnecessarily. These interruptions decrease workflow efficiency and negatively affect patient care.

Objectives
The goal of this project was to decrease clinical care interruptions from non-urgent pages to pediatric residents by implementing a priority indication system that was: (1) consistently used (90% pages with a priority level indicated); (2) clearly defined (80% concordance in the priority levels between senders and recipients); and (3) satisfying to end users (80% rating the paging system as satisfied).

Design/Methods
The Plan-Do-Study-Act method of quality improvement was used. The study was conducted at an academic children’s hospital, where numeric paging occurs through a switchboard operator. Three priority levels (1 being most urgent) with a respective expected callback time (5-15, 15-30, 60+ minutes) were determined through a pilot study and stakeholder consensus. A priority level was selected by the page sender and displayed beside a callback number.
Process measures were indication of priority levels and concordance of priority levels between senders and recipients. Outcome measures were reduced interruptions to clinical care from non-urgent pages and user satisfaction. Balancing measures included patient safety incidents. Run charts, surveys, and page logs were used to track the impact of interventions.

Results
In the first two months, 1325 out of 2208 (60%) pages had a priority level indicated. In the subsequent two months after providing feedback to users, the proportion increased to 1822 out of 2410 (76%). Subsequent bimonthly indication rates have ranged between 74% and 83%.
Among pages with a priority level indicated over 16 months (n=13,934), 26% were assigned priority 1, 62% priority 2, and 11% priority 3. There was a 74% concordance in priority levels between senders and recipients. 26% of pages were received while a resident was directly interacting with a patient. Fewer residents felt that their workflow was being frequently interrupted by non-urgent pages (from 65% to 39%). End user satisfaction improved. There were no patient safety incidents.

Conclusion
Using existing infrastructure, we implemented a paging priority indication system that decreased interruptions to clinical care. Residents reported improved workflow efficiency, and end users expressed improved satisfaction with paging communication. The gap in the perception of urgency between senders and recipients will need to be further evaluated. While a priority level indication is particularly pertinent to hospitals using numeric pagers, a standardized indication of priority levels can also be beneficial in hospitals using an alternative communication system.
39 Physical and social distancing measures and child health behaviours during COVID-19: A cohort study
Authors: Li Xuedi , Vanderloo Leigh , Maguire Jonathon , Keown-Stoneman Charles , Aglipay Mary , Anderson Laura , Cost Katherine , Charach Alice , Vanderhout Shelley , Birken Catherine 
Published: October 2021

Abstract

Primary Subject area
Public Health and Preventive Medicine

Background
Various studies have examined the general impact of the COVID-19 outbreak on children’s health behaviours. The impact of public health measures practised by children during COVID-19 is relatively unknown.

Objectives
The primary objective was to determine the association between physical and social distancing measures and children’s outdoor time, sleep duration, and screen time during COVID-19.

Design/Methods
A longitudinal study using repeated measures of exposures and outcomes was conducted in healthy children (0 to 10 years) between April 14 and July 15, 2020. Parents were asked to complete questionnaires about isolation, physical distancing practices, and children’s health behaviours. The primary exposure was the average number of days that children practised physical and social distancing measures per week. The three outcomes were children’s outdoor time, total screen time, and sleep duration during COVID-19. Linear mixed effects models were fitted using repeated measures of primary exposure and outcomes.

Results
This study included 554 observations from 265 children. Physical and social distancing measures were associated with shorter outdoor time (-17.2; 95% CI -22.07, -12.40; p &lt; 0.001) and longer total screen time (11.3; 95% CI 3.88, 18.79; p = 0.003) during COVID-19. The association with outdoor time was stronger in younger children (&lt; 5 years), and the associations with total screen time were stronger in females and in older children (≥ 5 years).

Conclusion
Physical and social distancing measures during COVID-19 have resulted in negative impacts on the health behaviours of Canadian children living in a large metropolitan area.
54 Body Mass Index vs Weight-for-Length in Infancy and Cardiometabolic Outcomes at Age 8-10 Years
Authors: Roberge Jean-Baptiste , Harnois-Leblanc Soren , McNealis Vanessa , van Hulst Andraea , Barnett Tracie A , Kakinami Lisa , Paradis Gilles , Henderson Mélanie 
Published: October 2021

Abstract

Primary Subject area
Public Health and Preventive Medicine

Background
The WHO provides body mass index (BMI) curves for infants 0 to &lt; 2 years old, but how these compare to the recommended method (weight-for-length [WFL]) in predicting later adiposity and cardiometabolic measures is uncertain.

Objectives
Our project aimed to: 1) confirm that WFL and BMI in infancy are associated with adiposity and cardiometabolic measures at 8-10 years old; and 2) compare the predictive ability of the two methods. We hypothesized that both methods would perform similarly.

Design/Methods
WFL and BMI Z-scores (zWFL and zBMI) at 6, 12, and 18 months of age were computed using data extracted from health booklets, used among participants in a prospective cohort study investigating the natural history of obesity and cardiovascular risk in youth (n = 464). Outcome measures at 8-10 years included adiposity, lipid profile, blood pressure, and insulin dynamics. The relationships between zWFL, zBMI, and each outcome were estimated using multivariable linear regression models. Outcome prediction at 8-10 years was compared between the two methods, using eta-squared and Lin’s concordance correlation.

Results
zWFL and zBMI were associated with all measures of adiposity at 8-10 years. Associations with other cardiometabolic measures were less consistent. For both zWFL and zBMI across infancy, eta-squared were highly similar and the Lin’s coefficients were markedly high (&gt; 0.991) for all outcomes.

Conclusion
zBMI measured in infants appeared to be equivalent to zWFL for predicting adiposity and cardiometabolic measures in childhood. This lends support to the sole use of zBMI for growth monitoring and screening of overweight and obesity from birth to 18 years.
58 Relationship Between Early Laboratory Measures and Neurological Injury in Neonates Undergoing Therapeutic Hypothermia
Authors: Kebaya Lilian , Ee Mong Tieng , Miller Michael , Bhattacharya Soume 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Hypoxic-ischemic encephalopathy (HIE) is a major contributor to morbidity and mortality. Therapeutic hypothermia (TH) is the standard of care for neonates with moderate to severe HIE. Brain magnetic resonance imaging (MRI) is the imaging modality of choice for confirmation of HIE, assessment of injury severity, and prognostication. Reliable, inexpensive and widely available laboratory measures for early identification of risk for neurological injury can play a critical role in the optimal management of neonatal HIE, especially in the resource-limited setting. Our study examined whether derangements in early routine laboratory measures (acid-base, haematological, metabolic) were worse in neonates with MRI findings of neurological injury.

Objectives
Primary objective: To evaluate the role of early laboratory measures in predicting neurological injury as detected by MRI at 72 hours. Secondary objective: To evaluate the role of early laboratory measures in predicting survival to NICU discharge in patients with HIE.

Design/Methods
This single-centre, retrospective cohort study included neonates ≥ 35 weeks gestation with moderate to severe HIE, who had undergone therapeutic hypothermia. Based on findings of brain MRI completed within 72 hours of life, our cohort was divided into 2 groups: neonates with, and without, evidence of neurological injury consistent with HIE. Baseline characteristics, as well as laboratory measures, were compared between groups, and a receiver operating characteristic (ROC) curve analysis was conducted to determine the cut-off for prediction of neurological injury based on the highest sensitivity and specificity values.

Results
104 neonates were analyzed. Baseline characteristics (Table 1) were similar between both groups, except for cord venous pH and base excess (BE), which were significantly lower in the abnormal MRI group (p = 0.02). In bivariate analysis, pH (at 1 h of age, p = 0.027), BE (at 1 h, p = 0.001, and 6 h of age, p = 0.004), ionized calcium (at 6 h of age, p = 0.02), and platelets (at 1 h of age, p = 0.004) were significantly different in neonates with abnormal MRI. In ROC curve analysis, BE at 1 h of life was the best predictor of abnormal MRI (AUC = 0.71, p = 0.002), with a cut-off value of ≤ -14.95, sensitivity of 67% and specificity of 66% (Figure 1).

Conclusion
Among neonates with HIE undergoing TH, early laboratory measures such as acid-base status, ionized calcium, and platelet count were worse in neonates with abnormal MRI, in comparison to neonates with normal MRI. Base excess at 1 h of life is a good predictor of abnormal MRI. Future prospective studies to validate these findings are needed
70 Sharing Child Health Knowledge in an Urban Inuit Community: A Needs Assessment
Authors: Bierstone Daniel , Hummel Brian , Newhook Dennis , Jetty Radha 
Published: October 2021

Abstract

Primary Subject area
Public Health and Preventive Medicine

Background
It is well established that significant health disparities continue to affect Canadian Indigenous children living both in remote and urban areas. A critical component of health promotion is health knowledge dissemination. A 2011 Health Council of Canada study identified the need for better community knowledge of parenting and child health as intervention targets among Indigenous communities across Canada.

Objectives
In the present study, we aimed to explore the perspectives of Inuit parents and caregivers in one urban setting (Ottawa, Ontario) on the dissemination of child health knowledge specifically, with the intention of guiding future community-based child health promotion initiatives.

Design/Methods
Ottawa, being home to the largest Inuit population living outside Inuit Nunangat, provided an ideal study location. Many Inuit report relocating to Ottawa for employment, education, or for greater access to heath services. We therefore partnered with the Ottawa-based Inuuqatigiit Centre for Children, Youth, and Families, to design and conduct a needs assessment through a series of focus groups. Focus groups explored participants’ current sources of child health knowledge, child health topics of interest, and preferred formats for child health knowledge dissemination. Focus groups were held at Inuuqatigiit and included a meal of country food shared by study participants and research team members to support relationship-building and engagement. Focus groups were analyzed using an inductive approach to qualitative thematic analysis.

Results
24 Inuit parents and caregivers participated in 4 focus groups. Factors affecting preferred sources of health knowledge included trustworthiness, fear of discrimination, cultural differences, and having a holistic approach. Participants identified several child health issues that should be the focus of future child health knowledge sharing initiatives, in particular those in which a sense of cultural dissonance was felt between traditional and Western approaches. In-person and online/interactive sessions were preferred over written materials. Many participants agreed that child health knowledge-sharing initiatives should be designed and delivered with involvement of the community. Participants also emphasized the importance of synthesizing traditional knowledge of Elders with that of health professionals.

Conclusion
There is a need for better child health knowledge dissemination strategies among the Ottawa Inuit community as a crucial aspect of health promotion. Special considerations when designing such initiatives must be given to historical dynamics of trust and mistrust of the health professions, to addressing cultural differences, and to the role of community members in the design and implementation of initiatives.
74 Central venous line-related thrombosis in neonates: A population-based study
Authors: Desjardins Marie-Pier , Hébert Audrey , Pelland-Marcotte Marie-Claude 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
The incidence of central venous line (CVL)-related thromboembolism (TE) in neonates is rising dramatically. The mainstay of treatment in neonatal thrombosis is anticoagulant therapy. However, management of neonatal CVL-related TE is particularly complex, as the higher risk of systemic and intracranial bleeding, especially in premature babies, must be balanced with the thrombotic risks, including death, or morbidity such as organ dysfunction, post-thrombotic syndrome, and neurodevelopmental sequelae. There is a paucity of evidence regarding the epidemiology of neonatal CVL-related thrombosis, to help clinicians identify neonates at high-risk of CVL-related thrombosis, as well as to tailor treatment based on the risks and benefits of anticoagulants in neonates.

Objectives
The objectives of this retrospective cohort study are: 1) to determine the main risk factors of CVL-related TE in neonates admitted to the neonatal intensive care unit (NICU); and 2) to compare the effectiveness and safety between different antithrombotic treatment modalities for neonatal CVL-related TE using the Canadian Neonatal Network (CNN) database and electronic medical chart review.

Design/Methods
Neonates ≤ 28 days of life admitted to the NICU for ≥ 24 hours requiring a CVL with TE confirmed by imaging were included in the study. The main effectiveness outcome is the resolution of TE, whereas the main safety outcome is the apparition of a major bleeding. In this study (n=39), we compared the effectiveness and safety outcomes according to antithrombotic treatment modalities (conservative vs. anticoagulation).

Results
The median gestational age is 35[26-38] weeks, and the mean birth weight is 2096±1110 g. CVL responsible for TE was umbilical venous catheter (28%), umbilical arterial catheter (46%), peripherally inserted central catheter (PICC line) (8%), and peripheral arterial catheter (18%). The anticoagulation therapy is more effective to achieve a partial and complete resolution of TE than the conservative treatment after a mean follow-up of 7 weeks (p=0.02). However, there were no differences according to antithrombotic treatment group regarding safety outcome assessed by major bleedings (p=0.2).

Conclusion
Our results tend to suggest that anticoagulation therapy is more effective to achieve resolution of CVLs-related TE than conservative treatment without compromising the safety of neonates. However, a large multicentric study is required to evaluate the risks and benefits of anticoagulants in neonates.
86 Virtual MacPeds: Leveling up to the new virtual reality of medical education
Authors: Mazze Nina , Zahn Kristen , Niec Anne , Ngo Quang 
Published: October 2021

Abstract

Primary Subject area
Medical Education

Background
The COVID-19 pandemic and physical distancing measures limited in-person learning experiences for resident postgraduate learners through mandated social distancing measures. Our training program responded by creating online synchronous and asynchronous learning opportunities to supplement learning and replace lost experiences. Virtual MacPeds is an online curriculum created using Kern’s six-step approach to curriculum development to supplement resident learning during COVID-19. The curriculum included online lectures, a live teaching calendar that includes links to sessions across rotations and subspecialties, and a resource rolodex with links to online learning materials.

Objectives
The purpose of this study is to evaluate the components of the Virtual MacPeds curriculum that were most useful to residents.

Design/Methods
Virtual MacPeds was piloted from March 2020 to June 2020 to 51 core pediatric residents in PGY1-4. The Kirkpatrick Model for learning evaluation was used to assess resident reaction to the implementation of the curriculum. A voluntary online survey was emailed to residents with the opportunity to respond from June to July 2020. Descriptive statistics were used to assess learner engagement and perception of the curriculum.

Results
Resident response rate was 38.2% (n=20, PGY1 =8, PGY2 =6, PGY3=5, PGY4=1). 95% of respondents had reduced in-person teaching sessions during COVID-19 and 80% had impacted clinical rotations (self-isolation, virtual care, patient volumes). Prior to Virtual MacPeds, 65% used online educational resources. 95% used the curriculum, all of whom found it helpful in fulfilling Royal College learning objectives. 85% of participants attended the online lectures - those who did not attend noted schedule conflict. 100% would use Virtual MacPeds in the future. Participants noted that Virtual MacPeds should include a live teaching schedule (100%), online lectures (84.2%), self-study modules (73.7%), resource rolodex (52.6%) with suggestions for recorded lectures (89.5%) and simulations (57.9%).

Conclusion
Virtual MacPeds is an acceptable and useful supplement to resident learning during COVID-19. Useful elements of the curriculum include online lectures, a live teaching schedule, resource rolodex and self-study modules.
92 Balint Groups: An Initiative to Help Residents Better Understand the Clinician-Patient Relationship
Authors: Finstad Warner , Jeong Dayae , Humphreys Joanna , Lord Sarah , Diskin Catherine , Lam Justin 
Published: October 2021

Abstract

Primary Subject area
Medical Education

Background
A Balint group is an educational tool that allows residents to reflect on challenging experiences with the doctor-patient relationship. Guided by trained facilitators, residents consider these cases from the doctor, patient and doctor-patient perspectives together with their colleagues. Balint groups can support the recognition of the emotional complexity underlying these interactions, which in turn reduces burnout, improves patient care and team dynamics, and strengthens professional identities.

Objectives
1) To evaluate the effect of Balint groups on trainees’ perceived comfort levels in navigating, debriefing, and supporting peers through challenging patient-physician encounters; 2) To evaluate the effect of Balint groups on the perceived culture of support within the paediatric residency program at the University of Toronto.

Design/Methods
The University of Toronto Pediatrics Residency Program incorporated Balint groups into the curriculum in 2018. Supported by faculty, residents led their introduction and improvement using Quality Improvement methodology. Outcome measures included perceived comfort levels in navigating and supporting peers through challenging patient-physician encounters, and the perceived culture of support within the program. Outcome measures were obtained using a 5-point Likert scale. Rates of group participation were collected as a process measure.

Results
All outcome measures improved between the first and second year of Balint group implementation. Residents’ comfort levels in navigating difficult patient-physician encounters increased from a mean of 2.5 (out of a 5-point Likert scale) to 3.0, in debriefing complex scenarios from 3.1 to 3.9, and in supporting peers from 3.2 to 3.8. The perceived culture of peer support improved from a mean of 3.5 to 4.2.

Conclusion
A Balint group is a reflective educational tool, which has a positive impact on residents’ experiences navigating patient relationships. Introducing these sessions at our institution has shown an encouraging trend in improving residents’ comfort levels with difficult clinical encounters and fostering a culture of support.