bluuebunny/crossref_metadata_2025_split huggingface dataset:
PERSPECTIVES ON NEONATAL RESUSCITATION TRAINING IN A CANADIAN PEDIATRIC RESIDENCY PROGRAM: COMMUNITY VERSUS TERTIARY CARE EXPERIENCES
Authors: Woodward Mary , Hunter Andrea , McConnell Meghan , Williams Connie 
Published: May 2018

Abstract

BACKGROUND
The competencies involved in neonatal resuscitation include a thorough knowledge of transitional neonatal physiology as well as technical expertise, the ability to lead a multidisciplinary team, and appropriate management of resources. In Canadian paediatric training programs, residents acquire neonatal resuscitation competency in both community and tertiary care settings. There is limited literature regarding experiences of training in variable settings and no literature with respect to the integration of neonatal competency acquisition across training environments.

OBJECTIVES
To explore residents’ and recent paediatric graduates’ perspectives on acquisition of competencies and neonatal resuscitation training in community and tertiary care centers.

DESIGN/METHODS
This project employed an interpretive design qualitative methodology, using an a priori educational theory incorporating the principles of social cognitive theory, deliberate practice, distributive practice, and ‘choke phenomenon’. Semi structured focus groups of residents and paediatricians were used for data collection. Interpretive analysis in the style of Crabtree and Miller was employed. Data validity was optimized through member checking and triangulation of themes across investigators. Validity criteria as described by Lincoln and Guba were applied. Institutional ethics board approval was obtained.

RESULTS
Overall, the participants described a large ‘disconnect’ (lack of communication and congruence of curriculum) between community and tertiary training environments for neonatal resuscitation. Inherent challenges in the community included the variable skill and experience of the interdisciplinary team, availability of resources, and a lack of confidence in their own leadership. In addition, gaps in preceptor knowledge and communication were identified. Strengths of the community setting included: more autonomy for the learner, a high volume of clinical cases with particular emphasis on the ‘normal’; and opportunity for observed feedback with preceptors. In comparison, tertiary center experiences were perceived to be ‘overwhelming’ with a demanding workload and limited opportunity for direct observation and feedback from faculty. Strengths of the tertiary center experience included: variety and high volume of acute clinical cases, facilitating technical skill expertise and self-confidence; and a strong academic focus on physiology and knowledge translation.

CONCLUSION
Participants described both valuable opportunities and challenges for training and competency acquisition in neonatal resuscitation in tertiary and community settings. Integration of curricula or competencies across settings and across residency level of experience was lacking. This work suggests areas for collaboration within and across training centres to align opportunities in neonatal resuscitation competency training.
USING CHEST COMPRESSIONS WITH ASYNCHRONOUS VENTILATION AT VARIOUS CHEST COMPRESSION RATES (90, 100, 120/MIN) – A RANDOMIZED CONTROLLED ANIMAL TRIAL
Authors: Patel Sparsh , Cheung Po-Yin , Lee Tze-Fun , Pasquin Matteo , O’Reilly Megan , Schmolzer Georg 
Published: May 2018

Abstract

BACKGROUND
The current Pediatric Advanced Life Support guidelines recommends that newborns who require cardiopulmonary resuscitation (CPR) in settings (e.g., prehospital, Emergency department, or paediatric intensive care unit, etc.) should receive continuous chest compressions with asynchronous ventilations (CCaV) if an advanced airway is in place. However, this has never been examined in a newborn model of neonatal asphyxia.

OBJECTIVES
To determine if CCaV at rates of 90/min or 120/min compared to current standard of 100/min will reduce the time to return of spontaneous circulation (ROSC) in a porcine model of neonatal resuscitation.

DESIGN/METHODS
Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia, which was achieved by clamping the endotracheal tube until asystole. Piglets were randomized into 3 CCaV groups: chest compression (CC) at a rate of 90/min (CCaV 90,n=7), of 100/min (CCaV 100,n=7), of 120/min (CCaV 120,n=7), or sham-operated group. A two-step randomization process with sequentially numbered, sealed brown envelope was used to reduce selection bias. After surgical instrumentation and stabilization an envelope containing the allocation “sham” or “intervention” was opened (step one). The sham-operated group had the same surgical protocol, stabilization, and equivalent experimental periods without hypoxia and asphyxia. Only piglets randomized to “intervention” underwent hypoxia and asphyxia. Once the criteria for CPR were met, a second envelope containing the group allocations was opened (step two). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment.

RESULTS
The mean (±SD) duration of asphyxia was similar between the groups with 260 (±133)sec, 336 (±217)sec, and 231 (±174)sec for CCav 90, CCaV 100, and CCaV 120, respectively (p=1.000; oneway ANOVA with Bonferroni post-test). The mean (SD) time to ROSC was also similar between groups 342 (±345)sec, 312 (±316)sec, and 309 (±287)sec for CCav 90, CCaV 100, and CCaV 120, respectively (p=1.000; oneway ANOVA with Bonferroni post-test). Overall, 5/7 in the CCaV 90, 5/7 in CCaV 100, and 5/7 in the CCaV 120 survived.

CONCLUSION
There was no significant difference in time to ROSC for either chest compression technique during cardiopulmonary resuscitation in a porcine model of neonatal asphyxia.
MATERNAL VIRTUAL INFANT NUTRITION SUPPORT CLINIC FOR THE NEONATAL INTENSIVE CARE UNIT (MAVINS-NICU) - A QUALITATIVE STUDY
Authors: Rai Stientje 
Published: May 2018

Abstract

BACKGROUND
Canadian exclusive breastfeeding rates at 6 months of age are only 24.2%, and are even lower in mothers of infants requiring Neonatal Intensive Care Unit (NICU) admission. An interactive website was developed that provides professional (articles, videos) and peer (discussion forum for peers, access to a lactation consultant) breastfeeding support to mothers of infants requiring NICU admission.

OBJECTIVES
The objective of the study is to outline maternal perceptions of the breastfeeding support website (MAVINS-NICU) in a level-III NICU setting.

DESIGN/METHODS
This study represents the qualitative research component of the MAVINS-NICU project. Semi-structured interviews were conducted antenatally with women at risk of delivering an infant requiring NICU admission (n=6), and postnatally with mothers of infants admitted to the NICU (n=7), regarding their experiences with the MAVINS-NICU website. Interviews were audio-recorded and transcribed by a professional transcriptionist. Analysis occurred in an iterative fashion using open and axial coding strategies to identify majors themes.

RESULTS
Several themes were identified: 1) Women seemed comforted that a reliable hospital-provided resource would be available to them after birth, “…I’m very happy that I’m going to have lots of support”; 2) Women felt overwhelmed after birth, but often accessed the website on their phone or read newly posted comments on the discussion forum in response to automatically generated weekly emails from the website, “I’m just, overwhelmed… because I’m [in the NICU a lot], I only have my phone and it’s just easier to look at the emails… [they] just pop up”; 3) Mothers felt extremely comforted by the peer support component of the website, “to see what other moms are going through … similar emotions or issues … to see that I’m not the only one [helps]”; 4) Mothers enjoyed remote access and quick online lactation consultant response times, “ … [you can] get help even when there’s no one around”, “I was really surprised … by how quickly I got responses”; 5) Majority of mothers expressed a sense of empowerment to provide breast milk with the help of MAVINS support, “…being able to breastfeed eventually is a big deal for me… [it made me feel] like I was accomplishing something”.

CONCLUSION
Mothers of infants admitted to the NICU found the MAVINS-NICU website very helpful and considered it part of their success in providing breast milk for their babies.
PROFILE OF RESISTANCE TO IVIG TREATMENT IN PATIENT WITH KAWASAKI DISEASE AND CONCOMITANT INFECTION
Authors: Poupart Steffany , Dionne Audrey , Le Cathie-Kim , Meloche-Dumas Léamarie , Turgeon Jean , Autmizguine Julie , Dahdah Nagib 
Published: May 2018

Abstract

BACKGROUND
Kawasaki disease (KD) is a paediatric systemic vasculitis that can be associated with concomitant viral or bacterial infections. Patients with persistent or recurrent fever 36 hours after the end of intravenous immunoglobulin (IVIG) are considered to be resistant to treatment and are at increased risk for coronary complications.

OBJECTIVES
However, it is unknown how concomitant infection influences the response to IVIG treatment. The aim of this study was to determine the impact of concurrent infection on the prevalence of IVIG resistance and coronary outcome.

DESIGN/METHODS
Retrospective study of 154 children (mean age at diagnosis: 3.4 ± 2.8 years) diagnosed with KD, between 2008–2016 in a tertiary paediatric university hospital, of which 59 (38%) had concomitant infection.

RESULTS
Delay in diagnosis (>10 days of fever) was similar between patients with and without concomitant infection (7% vs 7%, p=0.89). Patients with concomitant infection were more likely to have fever 48 hours after initial treatment (36% vs 20%, p=0.05) and to be treated with a second dose of IVIG (33% vs 18%, p=0.04). Patients with infection had higher C-reactive protein at the time of diagnosis (148 vs 112 mg/L, p=0.04), which persisted after IVIG administration (111 vs 59 mg/L at 48 hours, p=0.003). However, there was no statistically significant difference in the prevalence of coronary artery (CA) complications (coronary artery Z-score > 2.5) between patients with and without concomitant infection (36% vs 39%, p=0.68).

CONCLUSION
Children with KD and concomitant infection are more likely to have persistent fever and elevated inflammatory markers after treatment requiring a second dose of IVIG. Nevertheless, this is not associated with an increased risk of CA complications. Larger scale studies are needed to help distinguish IVIG resistance from infection in children with persistent fever and guide management of this population.
Table/Chart or graphic upload
IMPROVING TRANSITIONS IN CARE FOR CHILDREN WITH COMPLEX CARE NEEDS IN NOVA SCOTIA
Authors: Curran Janet , Vine Jocelyn , Breneol Sydney 
Published: May 2018

Abstract

BACKGROUND
Children with complex care needs are a small yet resource intensive population in Canada. At present, there is wide variation in the way in which this population is characterized in the clinical and research literature. Transitions from hospital to home for these children can be complicated by variation in available services and resources in their home community; complex technological logistics; and a sharp disjuncture between discharge instructions provided to families and implementation in their home communities.

OBJECTIVES
Develop policy recommendations for inclusion in a Nova Scotia strategy to support transitions in care for these children with medical complexity.

DESIGN/METHODS
We used a mixed method design. During phase 1 we developed six cases representing children with different levels of complexity. Cases were informed by parent and provider interviews at 4 time points, chart audits and validated measures of caregiver distress. In phase 2, we conducted key stakeholder interviews across Nova Scotia to identify barriers and facilitators to successful transitions in care. A multi-sector consensus meeting was held during phase 3 to discuss study findings and refine key recommendations for inclusion in a Nova Scotia strategy.

RESULTS
Six cases included children aged 15 days to 9 years old who were followed by as many as seven services and lived 50–300 km from IWK Health Centre. Key stakeholder interviews were conducted with 4 nurses, 4 physicians, and 1 administrator from 5 communities across Nova Scotia. A range of inter-institutional communication challenges and limited educational resources were identified as a key barrier. Participants identified the need for a nurse-coordinator role to act as a resource for both families and health providers in the community. A half-day consensus meeting 20 stakeholders from different health and government sectors was held. Proposed policy recommendations included: (1) consistent, timely, and discharge planning, (2) a comprehensive repository of resources for health care providers and families, (3) educational outreach strategy to build capacity for providers and families, (4) a nurse-coordinator role in each health zone to act a liaison and resource for health care providers and families, (5) work with existing provincial programs and services to develop policies and tools that are unique to a paediatric population, (6) adopt an established definitional framework for Children with Medical Complexity.

CONCLUSION
Our collaborative patient-centred approach to understanding how children with complex care needs currently navigate transitions in care in Nova Scotia provided a foundation for developing recommendations for a provincial strategy.
AUTISM SPECTRUM DISORDER AND ALTERNATIVE DIETS
Authors: Lemay Jean-Francois , McLeod Scott , AlTokhais Rana , Gibbard Ben 
Published: May 2018

Abstract

BACKGROUND
Complementary and alternative therapies are a frequent topic of discussion in the treatment of Autism Spectrum Disorder (ASD). In particular, several diets have been proposed to target ASD symptoms. Prior evidence has suggested limited benefit from such therapies, although they are commonly used in the ASD paediatric population.

OBJECTIVES
To determine the proportion of children and adolescents with ASD using alternative diets in our area. Other objectives were to explore reasons, information sources, symptom changes, and barriers to use of diets.

DESIGN/METHODS
We conducted a cross-sectional, anonymous, validated questionnaire with parents of children with a diagnosis of ASD. Participants were recruited to a collection of organizations and support groups dedicated to the provision of care for individuals with ASD. The 15-minute survey utilized a combination of closed-ended and short answer questions. Parents not able to understand written English were excluded.

RESULTS
Overall, 67 parents (response rate of 34%) participated. The male/female ratio of children was 3.6/1. Use of alternative diets (for >3 months) was reported by 74% of respondents. Parents learned about these diets from the Internet (44%) and ASD support group (40%). The diets most commonly used were: gluten-free (77%), low carbohydrate (58%), casein-free (56%), foods free of additives and preservatives (54%) and lactose free (49%). The most successful diet (according to parent report) resulting in improvement of ASD behavioral symptoms was gluten free (19%). Twenty percent reported no improvements with any diets. The reasons most commonly cited for change in diets were to: reduce ASD symptoms (65%), improve general health (63%), and mental/well-being health (61%). Most noticeable improvements were: reduced anxiety (36%), improvement of mood (31%), sleep (28%) and social communication (28%). Fixations and restriction interests were rarely reported as improved (<3%). Cost and following daily diet plan were the major challenges encountered. Parents not using modified diet cited lack of scientific evidence and not believing in diet therapy. Physicians were informed by parents about diet changes 61% of the time.

CONCLUSION
Alternative diets are frequently used by children with ASD. Parents are not reporting any specific diet as a “miracle” although they have noticed some benefits in general health. Paediatricians need to be aware of the common alternative diets used in patients with ASD. More research is necessary to understand benefits, challenges and risks from alternative diet use in ASD.
PARENTAL PERCEPTIONS OF MEDICATION IMPACT ON BEHAVIOUR AND LEARNING IN CHILDREN WITH ATTENTION/DEFICIT-HYPERACTIVITY DISORDER
Authors: Lemay Jean-Francois , Lemay Julie-Anne , Kubas Hanna 
Published: May 2018

Abstract

BACKGROUND
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often negatively impacts behaviour, cognition, and learning. Stimulant medications are the most commonly used treatment for ADHD, with informant reports (e.g., parent questionnaires, surveys) frequently used to evaluate medication impact on behavioural and academic functioning in affected children.

OBJECTIVES
To determine parental perceptions of medication impact on behaviour and learning in a long-acting methylphenidate (LA-MPH) trial of their children with ADHD.

DESIGN/METHODS
A randomized controlled LA-MPH medication trial was conducted with children ages 8–12 with a diagnosis of ADHD. Trial began with one-week of baseline assessment, followed by a randomized three-week standard of care medication trial, and a one-week best dose assessment. Following the conclusion of the study (6 months to 2 years’ range post-treatment), families were asked to participate in a voluntary follow-up phone survey to evaluate parental perceptions on child’s behaviour and learning.

RESULTS
A total of 34/42 (81%) families participated (male to female ratio: 2.1/1). At the time of the follow-up survey, 53% (18/34) and 68% (23/34) of patients were having “difficulty” or “significant difficulty” with their behaviour and learning, respectively. Twenty-three patients (68%) were still on psycho-stimulant medications. Although parents of those 23 children said LA-MPH had in general “significant” or “very significant” impact on their child’s behaviour (87%) and learning (79%), these parents were still reporting challenges with behaviour (52%) and learning (61%) at follow-up. In addition, parents of children not on medication said that their current child’s behaviour and learning was still having the same or more challenging issues (82% and 73% respectively).

CONCLUSION
Overall, parents reported that medication significantly impacted their child’s behaviour and learning; however, long-term medication impact appears less effective. Thus, an ongoing relationship with families and paediatricians is recommended to better understand the impact of medication on behaviour and learning. Evaluating the effects of medication on behaviour and learning may ultimately lead to targeted intervention that help foster long-term treatment efficacy for children with ADHD.
What are the Informational Preferences about Genetic Testing of Parents with Children with Autism Spectrum Disorder?
Authors: Lacelle-Webster Fanny , Mazumder Rinita , Hodgetts Sandy , Zwaigenbaum Lonnie 
Published: May 2018

Abstract

BACKGROUND
Autism Spectrum Disorder (ASD) affects more than 1% of the population. In 2009, the Canadian College of Medical geneticists recommended genome-wide microarray analysis as a first-line investigation for children with a diagnosis of ASD.

OBJECTIVES
The purpose of this study is to explore experiences and preferences of parents with children with ASD regarding information about genetic testing.

DESIGN/METHODS
In this mixed method study, parents of children with a diagnosis of ASD (age 2 to 17 years) were recruited through advertisements on websites and Facebook pages of community partners. The first step was an on-line survey housed on a secure web-based platform. In addition to demographic data, the survey collected information about the experiences and informational preferences of the parents about genetic testing. A subset of participants, based on expressed interest, participated in an in-person semi-structured interview. All interviews were recorded, transcribed and coded for major themes and sub-themes.

RESULTS
A total of 31 participants responded to the survey and 5 interviews were completed. Their children had received their diagnosis between 2004 and 2017. The online survey revealed that 69% of participants were aware of genetic testing and 38% had genetic testing completed. Overall, 94% wanted to have more information about genetic testing; notably, only 25% had heard about microarray. Receiving information about genetic testing was preferred in a follow up appointment by 56% of participants, but 28% preferred to receive information on the date of ASD diagnosis. Most participants (81%) identified their community paediatrician as the preferred physician to discuss genetic testing with them. Almost all interview participants were concerned that the information from genetic testing could be detrimental to their child, noting, for example, potential difficulties obtaining insurance coverage. Some shared their concerns regarding their paediatrician’s knowledge about genetic testing and ASD; in fact, two families decided to change to a new paediatrician to fulfill their needs of information about ASD and genetic testing.

CONCLUSION
This study showed that parents of children with ASD are globally interested to learn more about genetic testing, with their paediatrician being their preferred resource. For that reason, it appears important that paediatricians be aware of the recommended investigations for children with ASD and have a good understanding of the implications of genetic testing.
AN INTEGRATIVE AND COLLABORATIVE APPROACH TO ASSOCIATING ADVERSE BIRTH OUTCOMES AND INDUSTRIAL AIR POLLUTION
Authors: Serrano Lomelin Jesus , Nielsen Charlene , Jabbar M Shazan M , Wine Osnat , Zaiane Osmar , Vargas Alvaro Osornio 
Published: May 2018

Abstract

BACKGROUND
The relationship of many hazardous pollutants present in ambient air with adverse birth outcomes (ABO) is still unknown, particularly from those released by industry. The knowledge gap is even greater when considering the impact of mixtures of hazardous pollutants on pregnancy outcomes.

OBJECTIVES
We aimed to collaboratively overcome methodological limitations to identify potential hazardous mixtures of industrial air pollutants spatially related to the occurrence of ABO in Alberta.

DESIGN/METHODS
We applied integrative data analyses on large existing databases (2006–2012) from (i) the National Pollutant Release Inventory on chemicals released into air by industry; (ii) the Alberta Perinatal Health Program on births, known maternal risk factors for ABO, and the maternal postal code at birth; (iii) an area-level socioeconomic status index (SES). We developed a novel spatial data mining (DM) algorithm to identify significant spatial colocation rules of combinations of emitted chemicals and ABO (i.e., preterm birth [PTB], small for gestational age [SGA], and low birth weight at term [LBWT]). We used a Geographic Information System (GIS) to assign exposures to residences within 10 km of emission sites. We used epidemiological analysis to calculate the corresponding odds ratios of exposures to chemical mixtures and the occurrence of ABO, adjusted by maternal covariates and SES.

RESULTS
DM distinguished eleven rules combining three chemicals - gases, particulate matter and organics - as associated with ABO. GIS assigned exposure and epidemiological analysis identified seven rules with increased odds for induced PTB, SGA, and LBWT. One exclusively increased the odds for PTB (15%).

CONCLUSION
The combined interdisciplinary use of data mining, GIS, and epidemiology strategies enabled us to identify the risks associated with mixtures of hazardous chemicals and ABO – findings that proved elusive when applying methodologies individually. These discoveries enhance our understanding of the role of chemical mixtures in ABO.