bluuebunny/crossref_metadata_2025_split huggingface dataset:
113 Simplifying consent - Use of the novel integrated consent model in paediatric clinical research
Authors: Yeung Frances , Cameron Saoirse , Taheri Sepideh 
Published: October 2021

Abstract

Primary Subject area
Hospital Paediatrics

Background
Obtaining informed consent from patients to participate in clinical research has traditionally been a cumbersome process, often requiring lengthy documentation and the involvement of trained research staff. Moreover, this process can be a burden to the patient/family. As a result, progress in paediatric research and enabling continual improvement in care has been slow.
In the last decade, research ethicists have proposed a new “integrated consent model” (ICM) for obtaining informed consent for pragmatic clinical trials that compare standard-of-care interventions, where there is clinical equipoise. In most cases of ICM, only a brief discussion with verbal consent is required, along with a handout on study purpose, risks, benefits, and procedures. This allows for a more condensed consent process, which maximizes clarity and minimizes information overload. ICM also allows the patient/family to maintain prospective autonomy and decision-making, as compared with deferred or waived consent. The ICM model allows staff in the circle of care to obtain consent, which minimizes the stress of meeting an additional person. To our knowledge, ICM has not yet been used in the paediatric population.

Objectives
The objective of this abstract is to report on the utility of ICM in a non-randomized clinical trial carried out in the inpatient setting of a tertiary children’s hospital.

Design/Methods
We compared two widely accepted standards of care for maintaining peripheral intravenous catheter patency in a cohort of children, namely continuous infusion (“to keep the vein open” or TKVO) versus saline lock (SL). The ICM process was reviewed and approved by REB. Nurses in the circle of care received a study package that included an REB approved “consent script” to be read to the patient/family, a single page information sheet, and instructions on documenting the obtained verbal consent in the patient’s chart (Graphic 1).

Results
With ICM, 79% of participants were recruited into the trial by a nurse. Patient recruitment was completed 4 months ahead of the predicted schedule (Figure 1). Nursing, research, and medical staff were satisfied with ICM and found it easy to administer. ICM occurred smoothly and quickly for patients/families, with no interference with their medical care and practically no disruption to their daily schedule.

Conclusion
ICM is a practical alternative to laborious traditional consent models, is associated with higher patient recruitment rates, and is less burdensome for the patient/family. Paediatricians should be aware of the utility of this novel consent model.
117 Formal Leadership Teaching in Canadian Pediatric Residency Programs
Authors: D'Arienzo David , Dandavino Mylene 
Published: October 2021

Abstract

Primary Subject area
Medical Education

Background
Effective clinical leadership is known to improve clinical outcomes, health service delivery, effective resource allocation, and patient and staff satisfaction rates. Although it is well known that leadership skills can be taught and are necessary for all physicians, there are very few described residency-level structured leadership-training curricula. Yet, pediatric residency programs' Competence-By-Design (CBD) includes 19 stage-specific, leadership-focused Milestones, spanning 10 Entrustable Professional Activities (EPAs) that will need to be assessed.

Objectives
The purpose of this study was to map how leadership is formally taught in Canadian pediatric residency programs and to explore how leader-specific milestones and EPA are incorporated into programs’ training.

Design/Methods
Program Directors from all Canadian pediatric residency programs were invited to complete an online, anonymous survey, which was developed using the AMEE Seven-Step Survey Development guidelines. The survey explored demographics, teaching structure, teaching content and methods, assessment, and participants’ perspectives. Descriptive and thematic analyses were performed.

Results
Ten of the 17 pediatric programs directors responded to the survey. All program directors (n=10), stated that there is a need for mandatory, formal leadership teaching and formal leadership skills assessment for pediatric residents. Yet, half of respondents (n=5) reported no formal leadership teaching and residents' leadership skills are not formally assessed in three (of 10) pediatric residency programs. Additionally, none of the programs offers stage-specific leadership teaching.
Of the programs that offer formal leadership teaching, four programs’ teachings are stand-alone courses, while one program has a longitudinal leadership curriculum. Only one program offers formal teachings on leader-related CBD EPAs and/ or Milestones. Seven programs formally assess residents’ leadership skills. Of these, four programs use a formal assessment tool, while three programs do not use any assessment tool. None of the programs utilizes a validated or published leadership skills assessment tool.
Thematic analyses revealed that the common barriers to introducing a formal leadership curriculum include limited available time in residents’ teaching curriculum, lack of expertise and resources to teach leadership, and difficulty in assessing leadership skills.

Conclusion
Although residency programs identify leadership teaching and assessment as necessary, most pediatric residency programs lack formal leadership teaching and assessment. Additionally, no such teaching is stage-specific. Understanding the current state of programs’ leadership teaching will help better prepare programs for the integration of leadership milestones/ EPAs in the curriculum.
131 Characterizing atlanto-occipital dissociation and its association with pediatric traumatic cardiac arrest: A descriptive case series
Authors: Jeong Dayae , Freire Gabrielle , Beno Suzanne 
Published: October 2021

Abstract

Primary Subject area
Emergency Medicine - Paediatric

Background
Atlanto-occipital dislocation (AOD) is a type of cervical spine injury (CSI) that is commonly fatal or associated with severe neurologic consequences. Although rare, AOD is now more commonly recognized in children as improved prehospital care allows for more patients to reach trauma centres and undergo definitive imaging. Patients with AOD often present with cardiorespiratory instability and prompt diagnosis is crucial. However, diagnosis may be delayed due to variation in imaging practices and lack of literature on this topic.

Objectives
Primary objective: Describe the demographic characteristics, clinical presentation, and long-term outcomes of children with AOD, compared to other upper CSI. Secondary objective: Describe the frequency of AOD and other upper CSI in pediatric traumatic cardiac arrest (PTCA) and the utility of a lateral c-spine radiograph in this setting.

Design/Methods
This was a retrospective, single-centre case series of all pediatric trauma patients age &lt; 16 years diagnosed with upper CSI seen at a tertiary pediatric trauma centre from 2000-2020. Patients were included if they had evidence of bony or ligamentous injury from C0-2. The diagnosis of upper CSI was ascertained on autopsy, when available, then cross-sectional imaging, then plain radiographs, when the other modalities were unavailable. Data was obtained from manual chart review and analyzed using descriptive statistics.

Results
Thirty-six patients were excluded for not meeting upper CSI criteria. Of 93 patients with upper CSI, 24 had AOD: 14 (15%) complete and 10 (11%) incomplete (Table 1). The mechanism of injury was motor-vehicle-collision in 23 (96%) of these patients, and a fall in one (4%). All patients with complete AOD presented in PTCA and only one (7%) survived. Of seven patients with AOD who received a lateral c-spine x-ray during resuscitation, 5 (71%) had identifiable injuries. In contrast, of the 10 patients with incomplete AOD, only 1 (10%) presented in arrest and none died. Only one patient received an x-ray during resuscitation, which showed the injury but went undetected, and 100% of final diagnoses were made through CT. The majority of incomplete AOD patients were managed non-operatively and had minimal to mild disability.

Conclusion
In our study population, complete AOD was highly fatal with all patients presenting in PTCA. In contrast, incomplete AOD carried a more favorable prognosis with 100% survival and minimal-mild disability. If there is suspicion for AOD, a lateral c-spine XR in the trauma bay can aid in early diagnosis, guiding neurosurgical management and/or goals of care discussions.
134 Virus kinetics and biochemical derangements in children with Ebolavirus disease
Authors: Kjaldgaard Lindsey , Hawkes Michael , Claude Kasereka Masumbuko , Dixit Devika 
Published: October 2021

Abstract

Primary Subject area
Infectious Diseases

Background
In the second largest outbreak of Ebolavirus disease (EVD) on record (Democratic Republic of Congo, 2018-2020), 3470 cases were confirmed, 29% of them among children under 18 years of age.

Objectives
To describe virologic and biochemical characteristics of pediatric patients with EVD, and to compare these to a control group of adults with EVD.

Design/Methods
Retrospective medical record review of children &lt; 16 years old from two treatment centres in North Kivu, DRC. A control group of patients 16-44 years old was included as a reference comparator group. Patient demographics, serial measurements of viral load, serial biochemistry panel, and frequent point-of-care glucose test results were abstracted from the chart record. Funding provided by the Association for Health Innovation in Africa (AFHIA).

Results
Seventy-three children and 234 adults were included, admitted from April 24 to October 14, 2019. Pediatric patients commonly had electrolyte imbalances (36% hypokalemia, 52% hyperkalemia, and 74% hyponatremia), AKI (51%), elevated liver enzymes (median peak ALT 380 IU/L and AST 570 IU/L), and rhabdomyolysis (48%). Viral load at admission (7.2 versus 6.5 log10copies/mL, p=0.0001), peak viral load (7.5 versus 6.7 log10copies/mL, p&lt;0.0001), and time to clearance of viremia (16 versus 12 days p&lt;0.0001) were significantly different in children. Duration of hospital stay (20 versus 16 days, p&lt;0.0001) was prolonged in children, a direct consequence of slower clearance of viremia. There was no significant difference between groups in other laboratory values. Factors including ALT &gt;525 U/L, viral load (VL) &gt;7.6 log10copies/mL, BUN &gt;7.5 mmol/L, and CRP &gt;100 mg/L were associated with mortality in children, as in adults. In a multivariable logistic regression model, ALT and VL remained statistically significant independent predictors of mortality.

Conclusion
Pediatric patients with EVD, like adults, experience multi-organ involvement with life-threatening kidney and liver injury, rhabdomyolysis, and electrolyte imbalances. Pediatric patients have significantly higher viral loads throughout the course of EVD than adults.
138 Fluid overload in newborns undergoing abdominal surgery
Authors: Niknafs Nikoo 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Infants undergoing abdominal surgery, particularly those born preterm, are at risk of postoperative fluid overload and acute kidney injury due to immature cardiac and renal functions, which could contribute to increased morbidity and mortality.

Objectives
The purpose of this study was to evaluate the burden of fluid overload and acute kidney injury among newborns undergoing abdominal surgery and the association with adverse neonatal outcomes.

Design/Methods
Newborns who had undergone laparotomy from January 2017 to June 2019 admitted to a tertiary level Neonatal Intensive Care Unit were included in this retrospective cohort study. Fluid overload was assessed by the maximum percentage change in body weight and the difference between actual and prescribed fluid intake post-operatively. Acute kidney injury was defined as an increase in serum creatinine &gt;1.5 times of baseline or &gt;26 mmol/L, or oliguria (&lt; 0 .5mL/kg/hr over 24-hour).

Results
There were 60 eligible infants with medians [IQR] gestational age (GA) and birth weight being 29 weeks [25–36] and 1240 grams [721–2871], respectively. Indications for laparotomy included small bowel obstruction (45%), necrotizing enterocolitis (23%), and large bowel obstruction (11.7%). In the first three post-operative days, 24/60 (40%) required inotropes, 5/59 (8.5%) had hyponatremia (&lt;130 mmol/L), and 15/31(48.4%) developed hypoalbuminemia (&lt;20 g/L). 52/60 (86.7%) infants had serum creatinine measured and 4 (6.7%) fulfilled our AKI criteria.
The median of actual fluid intake was significantly higher than the prescribed fluid intake in the first 7 post-operative days (p&lt;0.01) [Figure 1]. Medians [IQR] of maximum % change of body weight within the first 3- and 7-days post operation were 6 [3–13] and 11 [5 –17], respectively. While we did not identify any associations between post-operative fluid overload and mortality/bronchopulmonary dysplasia in this cohort, we found that every 1% increase in weight gain within the first 3 days post-operation were associated with an increase in 0.6 day of invasive ventilator support (p=0.012) [Figure 2]. Such correlation still exists after adjusting for GA (p=0.033).

Conclusion
In our cohort of newborns undergoing abdominal surgery, weight gain within the first three post-operative days was associated with an increase in duration of invasive ventilator support. Fluid overload does not seem to be associated with acute kidney injury. Careful attention to intra and early postoperative fluid balance may play an important role in optimizing outcomes of newborns undergoing abdominal surgery.
139 Understanding the Psychosocial Impact of the Novel Coronavirus Pandemic – A Focus on Children and Families
Authors: Gander Sarah , Flood Kate , Campbell Sarah , Bonner Katie 
Published: October 2021

Abstract

Primary Subject area
Social Paediatrics

Background
The novel coronavirus (COVID-19) pandemic is a major global threat that emerged in 2020. Many countries have enacted policies such as mandatory school closures, business closures, and self-quarantining to keep people at home and prevent further spread of the virus. Previous research has shown that pandemics and subsequent disease containment measures negatively affect children and families, both psychosocially and economically.

Objectives
The current study explores the potential psychosocial impacts of the COVID-19 pandemic and subsequent disease containment measures on a number of domains (employment/business, education, finances, medical care, access to medication, technology, children/family, access to community services) through an online survey. The current abstract focuses on the emotional well-being of children and how families have been affected by the restrictions and changes related to the COVID-19 pandemic.

Design/Methods
Participants were asked to complete an online survey through a secure portal. The survey consisted of questions about household demographics and socio-economic status (SES), as well as five psychometric scales measuring satisfaction with life, psychological well-being, anxiety, depression, and substance use, and specific questions about how the COVID-19 pandemic has impacted respondents’ daily lives in the previously identified domains. This is the first of four longitudinal surveys that will be conducted throughout this study.

Results
A total of 571 participants completed the survey. Of these participants, 41.3% identified as being a parent or guardian with children under 18. The focus of this abstract is the subset of respondents with children. Roughly three quarters of participants identified that their children were emotionally impacted by COVID-19, the school closures, or missing friends or family (Yes = 46.6%; Somewhat = 30.5%). Parents also reported loss of access to childcare, disruptions to their visits with their children living outside the home, and feeling like they could not access timely medical care for their children. Demographic information and other relevant responses and information can be found in Tables 1 and 2, respectively.

Conclusion
The impacts of the COVID-19 pandemic will be felt for years to come and will shape an entire generation of children. Even in the current sample, which consisted largely of individuals from medium-high SES households, most reported that children had been impacted emotionally. Understanding and mitigating the impact on children and adapting resources in the short term and the long-term to meet the growing needs of our communities must be top priorities for pediatricians and community service providers.
141 Sickle cell disease and physical activity: Is it safe?
Authors: Corvalan Cifuentes Melissa-Zoraya , Pastore Yves D , Nguyen Thanh-Diem , Bérubé Denis , Dahdah Nagib 
Published: October 2021

Abstract

Primary Subject area
Hematology and Oncology - Paediatric

Background
Though physical activity (PA) is beneficial for healthy individuals and for those with chronic disease, its impact on sickle cell disease (SCD) children remains poorly studied. Moreover, patients may refrain from PA given a perceived fear of SCD complications.

Objectives
1) Evaluate whether SCD children engage differently in PA compared to their peers. 2) Evaluate the cardiopulmonary impact of PA in a group of SCD patients.

Design/Methods
Prior to the COVID-19 pandemic, SCD patients aged 8-17 years old consented to answer a PA questionnaire (PAQ) and have their school peers answer the same PAQ. PAQ, a well-described surrogate marker of PA, is a standardized questionnaire evaluating PA during the last 7 days. Patients and their peers were approached only during the school year. A set of HbSS patients were invited to participate in a supervised exercise test including pre- and post-effort PFT, echocardiography, EKG, measurement of troponins and NT-proBNP and a methacholine challenge to evaluate exercise-induced bronchial hyperreactivity. T-test was used as statistical analysis, using SPSS V24. The study received IRB approval.

Results
Questionnaires from 25 SCD children (13 SS and 12 SC) were compared with 36 matched-school peers. SCD patients were overall less active (p=0.04). While their level of activity was similar at school, SCD patients were overall less active after school (p=0.028), in the evening (p=0.008) and weekends (p=0.049). While the difference was significant for both SS and SC patients, SS were less active than SC, although this difference was statistically not significant. Five HbSS patients on HU were subjected to an exercise test. There were no statistical differences in the pre- and post-PA evaluations including measurements of troponin, NT-proBNP and functional testing. None of them had exercise-induced hyperreactivity.

Conclusion
Overall, SCD patients are less active than their peers, mostly outside of school. The absence of cardiopulmonary modifications during PA is reassuring, although our study was limited to 5 HbSS patients on HU. Whether HU has a protective role cannot be excluded. Our results encourage us to further evaluate PA interventions outside of school in SCD patients. Interventional studies evaluating the risk-benefit ratio of PA in SCD children are further needed.
143 Rh-Disease Awareness and Prevention (RhAP): Knowledge Assessment of Obstetrical Patients
Authors: Woolf Maya , Nallathamby Shanthiya , Gnanalingam Aasha , Sgro Michael , Berger Howard , Baker Jillian 
Published: October 2021

Abstract

Primary Subject area
Maternal-Fetal Medicine

Background
Rhesus hemolytic disease of the newborn (RhD) was once the most common and severe form of hemolytic disease of the newborn with outcomes including anemia, jaundice, stillbirth and death. Approximately 15% of Canadian women are Rh-negative, yet RhD is relatively unknown due to prevention by Rh immunoglobulin (RhIG). There is a need to advocate for the ongoing prevention of RhD in high-income countries (HICs) due to low incidence, vaccine hesitancy and misinformation, and in low-income countries (LICs) where lack of access to RhIG contributes to over 350,000 annual cases worldwide.

Objectives
Our present aim is to assess the current state of knowledge of RhD among women in our centre.

Design/Methods
Questionnaires were administered to a consecutive sample of pregnant women of all blood types (5-42 weeks gestation) attending an urban Obstetrics Clinic between January - March 2020, and included demographics and self-reporting of current RhD awareness.

Results
Of the 586 participants surveyed, 43% did not know their blood type and 16% identified as Rh-negative (Table 1). Sixty-one percent of participants recalled receiving information about their blood type, and only 31% knew their partner’s blood type. Only 45% of the Rh-negative subset (Table 2) in their third trimester (or postpartum) knew that they had been given RhIG (routinely offered at 28 weeks gestation). While 84% of Rh-negative women had received information about RhD from various sources (physician, online, etc.), there was a lack of depth in their knowledge with two-thirds having no knowledge of the common sequelae of RhD. The majority of Rh-negative participants expressed interest in contributing to local efforts (58/92), including interest in our advocacy group.

Conclusion
As expected, many participants did not know their Rh status, despite routine testing in pregnancy. Many were unaware of the potential sequelae associated with RhD and rationale for its prevention, even in the Rh-negative subgroup. Not all Rh-negative women were aware of having received RhIG, presumably having received it without knowledge or understanding. We are concerned that lack of awareness, especially among Rh-negative women in HICs may lead to increased complacency, RhIG refusal, and missed opportunities for patient self-advocacy. Our questionnaire results provide further impetus to advocate for increased RhD education for the patients and their care providers. Next steps include the creation of a patient-led focus group that aims to improve local and global awareness of RhD to help decrease the burden of this potentially devastating and preventable disorder.