bluuebunny/crossref_metadata_2025_split huggingface dataset:
40 Provider Perspectives of a Pediatric Patient Portal
Authors: Goldbloom Ellen , Courtney Jennilea , Barrowman Nick , deBoer Jennifer , Teitelbaum Mari , Macaulay Karen , DeGiovanni Tammy , King W James 
Published: October 2021

Abstract

Primary Subject area
Technology

Background
Patient portals (PPs) can enhance patient engagement and have potential to improve quality of care. However, despite positive perceptions of them by patients and their families, adoption remains low. Since provider promotion of PPs has been shown to impact patient activation and use, understanding providers’ perspectives of PPs is a critical component to successful implementation and impact. Yet there is sparse information, beyond anecdotal reports, about provider opinion, particularly in pediatrics.

Objectives
We sought to evaluate clinician perceptions regarding the implementation of a PP in a pediatric environment.

Design/Methods
An electronic survey was sent to all clinicians in a pediatric tertiary health centre. Perceived and expected PP usefulness/usability, impact on clinician-patient/family relationships, workload, security, privacy, and medicolegal risk were evaluated, as well as overall attitude toward PP adoption and interest in future PP functionality. Descriptive statistics were calculated and analyzed for all survey items.

Results
Four hundred and seventy-three participants (87% female; 71% &lt; age 50 years; 26% physicians) completed the survey (24% response rate) representing a broad range of clinical areas and PP experience. Respondents understood (94%), accepted (92%), and agreed (89%) that PP implementation provided better patient access and care. Only 24% of respondents felt their PP training was adequate. Clinician observations of their patients and families using the PP are displayed in Figure 1. While 86% of clinicians reported that the PP had not changed their overall workload and productivity, 41% felt it would increase as more patients become active. There were minimal PP-related privacy/security concerns, but 24% of respondents felt their medico-legal risk concerns would increase with a PP, as more patients become active. Seventy-nine percent of respondents reported that PP use does not change the quality of care they deliver. Forty-six percent would like their patients to be active on the PP, while 48% were indifferent. Future portal functionality favoured scheduling, questionnaires, and e-visits.

Conclusion
While the justification for PP implementation is acknowledged, compared to existing literature and current patient experiences, clinicians underestimate their potential value, overestimate their impact on workload and patient anxiety, and feel that they need more training to properly use a portal. These results will guide the next steps in PP optimization locally, and should aid other centres in understanding and addressing clinician concerns, with the goal of improving PP activation and use. Although concerns about PPs cited by providers are largely unfounded, they persist and remain a barrier to optimal leveraging of this tool.
48 Chronic kidney disease prevalence and glomerular filtration rate trends in children with type 1 diabetes
Authors: Favel Kristen L , Mammen Cherry 
Published: October 2021

Abstract

Primary Subject area
Nephrology

Background
Children with type 1 diabetes (T1D) are at risk for acute kidney injury (AKI) secondary to diabetic ketoacidosis, as well as chronic kidney disease (CKD) from diabetic nephropathy.

Objectives
The primary objective of this study was to assess the prevalence of abnormalities in estimated glomerular filtration rate (eGFR) in children with T1D. As a secondary objective, we sought to explore the relationship between clinical characteristics and trends in eGFR.

Design/Methods
This ambispective cohort study involved children aged 18 years or younger with T1D (n = 420), followed in the diabetes clinic at British Columbia Children’s Hospital (BCCH), the tertiary pediatric hospital in Vancouver, British Columbia, Canada. Data was collected from the BCCH paper and electronic health records. CKD was defined as eGFR less than 60 mL/min/1.73 m2. Being at risk of CKD was defined as having a mildly decreased eGFR (60 to &lt; 90 mL/min/1.73 m2) and/or hyperfiltration (eGFR ≥140 mL/min/1.73 m2). eGFR was calculated using the modified Schwartz formula (36.5 x height in cm / serum creatinine in umol/L). Linear regression analysis was used to describe the relationship between eGFR and duration of T1D.

Results
Of the 420 participants, 225 (54%) were male, with a median age at T1D diagnosis of 6.1 years and T1D duration of 4.8 years (range &lt; 1.0-15.0 years). One-hundred and eighty-six (44%) children were hospitalized for DKA, of which 89 (48%) developed AKI. No participants had an eGFR &lt; 60 mL/min/1.73 m2, and 317 (76%) had normal renal function. Fifty-one participants (12%) had an eGFR &lt; 90 mL/min/1.73 m2, and 52 (12%) demonstrated hyperfiltration. When analyzed as a cohort cross-sectionally based on duration of T1D, there was a significant linear decline in eGFR of 1.4 ml/min/1.73 m2 per year (95% CI -1.95, -0.87 mL/min/1.73 m2).

Conclusion
In a large group of pediatric patients with type 1 diabetes, 24% were at risk for chronic kidney disease based on a mildly decreased GFR and/or hyperfiltration. The pattern of eGFR decline over time is concerning and relevant, as this cohort is at risk for CKD secondary to diabetic kidney disease. Strategies are needed to improve the follow-up and management of early CKD in children with type 1 diabetes to maintain their renal function into adulthood, and more studies are needed to quantify further change in eGFR in the young adult population.
51 Donor Milk in the NICU: A Community Pediatrics Perspective
Authors: Stoltz Tasha , Jones Aaron , Rogers Lynn , Sidhu Hargun , Patel Rina , Shamsuddin Adib , Lee Catherine , Graham Campbell , Costa Andrew , Rosner Jodi 
Published: October 2021

Abstract

Primary Subject area
Community Paediatrics

Background
Use of pasteurized donor human milk (PDHM) has been recommended as an alternative to formula for preterm or low birth weight infants when mom’s own breast milk (MOM) is unavailable. Studies show that compared to PDHM, formula-fed neonates had better growth rates but were at increased risk of necrotizing enterocolitis (NEC) and feeding intolerance. Notably, most of these studies were conducted in tertiary-level NICUs. The Canadian Paediatric Society recommends PDHM as an alternative to formula for neonates admitted to NICUs. However, at time of study, PDHM was not offered in many community NICUs.

Objectives
The aim of this project is to determine whether the introduction of donor milk in the Level 2B NICU at Grand River Hospital has made a difference in rates of suspected NEC, feeding intolerance, growth, and length of hospital stay.

Design/Methods
We conducted a retrospective pre-post study comparing medical records of neonates in the NICU who met the criteria to receive PDHM 2 years after the introduction of PDHM at our centre (October 2017 to September 2019) to neonates who met the same criteria but were admitted prior to introduction of PDHM (October 2015 to September 2017) and thus received formula. Neonates who received privately purchased donor milk were excluded from our analysis.

Results
Gestational age and birth weight was similar for the PDHM (n=127) and control (n=120) groups. Compared to the PDHM group, formula-fed neonates were more likely to be transferred to a tertiary care NICU for concerns of suspected NEC (8.9% vs. 3.1%, p=0.017). When comparing any feeding intolerance, there was no significant difference between the two groups (p=0.23). Neonates receiving PDHM had higher average daily weight gain (33.9 vs. 28.9, p &lt; 0 .001), but were more likely to receive additional calorie supplementation. There were no differences in length of hospital stay.

Conclusion
The data from our community NICU support the current literature that infants who receive formula are at increased risk for transfer for suspected NEC compared to those who receive PDHM. However, in our centre, there appears to be no difference in rates of feeding intolerance, and neonates fed fortified PDHM appeared to have better growth rates. Results from this study can be used to guide the allocation of health care resources, and can be applied to other community centres. Future studies can look to replicating these results on a larger scale and analyze the cost-effectiveness of PDHM use in community centers.
63 Characterizing Organizational Risk Factors and Clinical Impacts of Unplanned Extubations among Infants in the Neonatal Intensive Care Unit
Authors: Le Blanc Gabriella , Jabbour Elias , Patel Sharina , Zeid Marco , Shalish Wissam , Kazansteva Olga , Beltempo Marc 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Organizational factors in neonatal intensive care units (NICUs) can increase the risk of adverse events, such as unplanned extubations (UPEs). UPE is the premature and unanticipated removal of an endotracheal tube. UPE and subsequent reintubation may increase the risk for lung injury and bronchopulmonary dysplasia (BPD) among preterm infants.

Objectives
First, we aimed to assess the association between daily nursing overtime and UPEs in the NICU. Second, we aimed to evaluate the association between UPE, re-intubation after UPE, and BPD in the sub-group of infants born &lt; 29 weeks’ gestational age (GA).

Design/Methods
We conducted a retrospective cohort study including infants admitted to a tertiary care NICU between 2016-2019. Daily nursing hours were obtained from local administrative databases. Patient data was collected from the local Canadian Neonatal Network database. Association between ratio of daily nursing overtime hours/total nursing hours (OTR) was compared between days with and without UPEs, using logistic regression analyses. Associations between UPE and BPD among infants born &lt;29 weeks requiring mechanical ventilation was evaluated in a 1:1 propensity-score matched (PSM) cohort. Infants were matched based on GA ± 2 weeks, mechanical ventilation days at time of UPE ± 5 days and SNAPII&gt;20.

Results
There were 108/1370 (7.8%) days with ≥ 1 UPE, for a total of 116 UPE events from 87 patients (23-42 weeks GA). Higher median OTR was observed on days with UPE compared to days without (3.3% vs. 2.5%, p=0.01). OTR was associated with higher adjusted odds of UPE (aOR 1.09, 95% CI 1.01-1.18), while other organizational variables were not (Table 1). Among ventilated infants &lt;29 weeks’ GA (n=XX), UPE rate was 31% (59), BPD rate was 42% (81) and re-intubation rate after UPE was 59% (35). In the PSM cohort of infants &lt;29 weeks, re-intubation after UPE, was associated with increased length of mechanical ventilation (aOR 16.45; CI 6.18, 26.72) as well as increased odds of BPD, when compared to infants not requiring re-intubation (aOR 4.97, 95% CI 1.54-18.27) (Table 2).

Conclusion
Higher nursing overtime was associated with increased UPEs in the NICU. Re-intubation was frequently required after a UPE. Among the infants born &lt; 29 weeks’ GA, UPE requiring reintubation was associated with increased total length of mechanical ventilation and increased risk of BPD. Our findings highlight the role of workforce management in improving outcomes in the NICU, through reducing the incidence of UPEs.
71 Adrenal Insufficiency among Children treated with Hormonal Therapy for Infantile Spasms
Authors: Doré-Brabant Gabrielle , Laflamme Geneviève , Millette Maude , Chrestian Nicolas , Osterman Bradley 
Published: October 2021

Abstract

Primary Subject area
Endocrinology and Metabolism

Background
Hormonal therapy is a standard treatment for children with infantile spasms. However, the high doses given and long treatment duration exposes patients to the potential risk of adrenal insufficiency (AI). There is, presently, limited data on occurrence of AI after hormonal therapy in this population.

Objectives
This study aims to quantify the incidence of AI among children with infantile spasms treated with high-dose corticosteroids and/or adrenocorticotropic hormone (ACTH).

Design/Methods
A retrospective chart review of patients less than 2 years old treated for infantile spasms was performed between January 2009 to March 2020 in one pediatric specialized hospital. Variables collected included sex, age, etiology, age at treatment initiation, type of hormonal treatment, dose and duration of treatment, concomitant medication and illness, other corticosteroid uses, hydrocortisone replacement therapy use, adrenal function testing, and signs of AI. Analysis included descriptive statistics, such as incidence and bivariate analysis.

Results
Thirty-one patients met the inclusion criteria and received a total of 33 separated courses of hormonal treatment. Adrenal function following each course of treatment was evaluated in all patients, either by tests or by the presence of adrenal crisis. Oral hydrocortisone replacement therapy was received by 32/33 (97%) children. AI occurred in 25/33 (76% [95% CI 58-89]) children. There was no predictive factor for adrenal insufficiency after hormonal treatment, and no drug regimen (duration or total received dose) was safe. Two patients (6%) presented to the emergency room with an acute adrenal crisis the day following the weaning off of hormonal treatment. They were the youngest children of the cohort, with an age of 1,6 and 2,7 months at the initiation of treatment. All other patients were aged 4 months and older.

Conclusion
This study suggests that adrenal suppression is frequent after standard hormonal therapy regimen for infantile spasms. This can lead to serious complications, such as adrenal crisis, if not supplemented. A routine laboratory assessment of adrenal function should be done after hormonal therapy for all patients. We suggest that hydrocortisone replacement therapy should be given at the end of hormonal therapy and until testing results for adrenal function are obtained, particularly for younger patients.
79 What we know about acute pediatric cannabis poisoning: A scoping review
Authors: Elliott Sarah , Gaudet Lindsay , Hogue Kaitlin , Scott Shannon , Hartling Lisa 
Published: October 2021

Abstract

Primary Subject area
Emergency Medicine - Paediatric

Background
Liberalization of cannabis policy in Canada has led to concerns that increasing access to cannabis and cannabis infused products (e.g. edibles) for adults will have negative, unintended consequences for children.

Objectives
We conducted a scoping review to map the available evidence on the public health implications, clinical management, and experiences and information needs of healthcare providers (HCP) and parents, relating to acute cannabis poising in children.

Design/Methods
We searched three databases (Medline, CINAHL, and PsychINFO) from inception until October 2019. Grey literature was searched up to March 2020. We included all records (primary research, knowledge synthesis, editorials, letters/opinion pieces, government websites and news articles) reported in English or French. We defined acute cannabis poisoning as unintended exposure to cannabis or cannabis product(s) that led to the need for acute medical advice or treatment. A primary reviewer screened all identified publications and a secondary reviewer screened excludes. Records were categorized by area (public health implications, clinical management, experiences and information needs) and mapped based on reported outcomes and record type.

Results
We identified 4644 records and included 158 (knowledge syntheses [n=3]; primary research [n=95]; editorials, commentaries, and letters [n=18]; education or media for HCP [n=15]; and education or media for the public [n=27]). Public health implications were addressed by 129 (82%), often reporting increasing incidence of acute paediatric cannabis poisonings. 116 records (51 [44%] case studies) reported or discussed clinical characteristics and/or management of acute paediatric cannabis poisoning, including signs and symptoms (92%), use of toxicology screening (60%), type of clinical management (52%) and treatment recommendations (36%). Few sources addressed either HCP (n=5) or parent (n=1) experiences or information needs.

Conclusion
The increasing incidence of acute cannabis poisonings and liberalization of cannabis legislation is clear, however, evidence around the clinical management is limited. Rigorous studies of suggested clinical treatments are needed to develop an evidence-base from which data can be synthesized and appraised, in order to drive the development of clinical recommendations. Additionally, further research exploring HCP and parent experiences and information needs around cannabis poisoning is warranted.
88 Family Absence at the Bedside during the COVID-19 Pandemic
Authors: Dharmaraj Blossom , Diskin Catherine , Orkin Julia , Agarwal Tanvi , Parmar Arpita , Karmali Karima , Friedman Jeremy 
Published: October 2021

Abstract

Primary Subject area
Hospital Paediatrics

Background
Child and family-centered care, a partnership approach to health care decision-making, is central to paediatric practice. To reduce transmission of SARS-CoV-2, healthcare institutions implemented policies to protect staff, patients and families. Family presence at the bedside was reduced to one caregiver, except in special circumstances requiring pre-approval by hospital leadership.

Objectives
We explored the impact of the COVID-19 pandemic on paediatric healthcare delivery, focusing on family presence. We describe the clinician's experience of restricted family presence during the COVID-19 pandemic in a paediatric hospital.

Design/Methods
Physicians, trainees, and nurses at The Hospital for Sick Children completed surveys between March-August 2020 to identify patients they perceived to have experienced a suboptimal quality of care or health-outcome related to changes that had occurred as a result of the pandemic and describe the impact. Data were analyzed via case report and thematic analysis. As part of a larger study, here we report on cases related to family presence in the hospital.

Results
A total of 212 clinicians reported 116 cases; eighteen cases specified an impact on child and family-centered care. Nine cases related to patient experiences and nine to family experiences of the restricted family presence policy. Clinicians reported a perceived distress in patients due to family members not being present. 6267 family restriction exemption requests were received. Cases described families who opted for a different location for end-of-life care so that extended family could be present. Further cases highlighted how important conversations such as disclosure of diagnosis involved one parent present and the other joining remotely. Siblings were also reported to be impacted by visitor restrictions and closure of the sibling play area. Exclusions were also reported to be challenging for children with complex medical needs and technology dependency whereby two-caregivers were often required. Clinicians reported experiencing stress and moral distress as part of being required to support family restriction policies, impairing their ability to provide care.

Conclusion
Family presence policies are a critical component of child and family-centered care and have been impacted by the pandemic as described both by family and clinician stress. Recommendations based on these findings would include: facilitating two-caregiver presence to support shared decision making, regular remote meetings to communicate information with families in cases where they cannot be physically present; using remote technology or implementing allotted visitation time for siblings, reviewing exceptions to caregiver restrictions, and mental health supports for clinicians such as peer-support groups, or wellness workshops.
89 The Unintended Consequences and Impact of the COVID-19 Pandemic on Patients, Families and Clinicians in a Children’s Hospital
Authors: Diskin Catherine , Orkin Julia , Dharmaraj Blossom , Agarwal Tanvi , Parmar Arpita , Friedman Jeremy 
Published: October 2021

Abstract

Primary Subject area
Hospital Paediatrics

Background
The coronavirus (COVID-19) pandemic has broad implications for children and families. Healthcare experience and delivery has changed significantly, and changes will likely continue for some time. Particular attention has been paid to delays in accessing timely pediatric care leading to unintended morbidity.

Objectives
This study aimed (1) to describe the broader spectrum of unintended negative consequences by describing the courses of care altered by the COVID-19 pandemic from the clinician's perspectives and (2) to identify thematic similarities to inform clinical practice change.

Design/Methods
All full-time doctors, dentists, and nurse practitioners working at a tertiary care children’s hospital in Canada were surveyed every two weeks throughout the initial phase of the COVID-19 pandemic. We asked them to identify and describe clinical cases in which they perceived a negative outcome associated with hospital or societal changes due to the COVID-19 pandemic. Analysis followed a qualitative case series methodology using a narrative synthesis approach to determine similarities and associated themes.

Results
Two-hundred and twelve clinicians reported 116 cases. Several broad themes emerged, including (1) timeliness of care, (2) disruption of child and family-centred care, (3) new pressures in the provision of safe and efficient care and (4) inequity in the experience of the COVID-19 pandemic. Within each of these themes, subthemes emerged, highlighting its impact on (1) patients, (2) their families and (3) healthcare providers. Table 1 provides examples of cases within each theme.

Conclusion
The broad consequences of the COVID-19 pandemic impact patients, families, healthcare providers and the healthcare system. Understanding this breadth is necessary as we strive to deliver safe, high quality, family-centred pediatric care in this new era. As the pandemic continues, we need to consider carefully how to provide elective and ambulatory care, including surgery, in this era of social distancing. Particular attention is needed to understand particular aspects, including vulnerable children and the clinician experience of the COVID-19 pandemic.