bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHROMOSOMAL MICROARRAY TESTING IN A DEVELOPMENTAL PAEDIATRICS SETTING
Authors: Jenkin Brock , Mitchell Clare 
Published: May 2018

Abstract

BACKGROUND
Current guidelines recommend chromosomal microarray (CMA) testing as a first line etiologic investigation for developmental disorders such as intellectual disability or autism spectrum disorder (ASD). How often a copy number variation (CNV) is found, a definitive etiologic diagnosis is made and a change in clinical management occurs has not been well studied in a community setting.

OBJECTIVES
The study objective was to examine the real world use of CMA testing in a developmental paediatric setting: the prevalence of positive results and management decisions.

DESIGN/METHODS
This was a retrospective, descriptive study. The charts of 170 children seen by a single developmental paediatrician in a small city over a 7 year period (2010 - 2017) were reviewed. Referrals were received from both urban and rural communities. Information regarding reason for referral, clinical diagnosis, requests for CMA testing, test results and subsequent management decisions were extracted. The patient age ranged from 1 to 18 years (average 5.1 years). Children were referred for a wide variety of developmental and behavioural problems. Developmental delay, disruptive behavior, possible autism spectrum disorder or speech delay were the most common reasons for referral. Children were considered for CMA testing according to published guidelines. The most common clinical diagnoses in referred children were attention deficit hyperactivity disorder (ADHD), ASD and global developmental delay (GDD). Clinical management decisons were obtained from the medical chart and included follow-up visits.

RESULTS
CMA testing was recommended for 78 children, of which 65 had CMA testing completed (83%). Of these, 15 (23%) had an abnormal result and 6 (9%) were deemed pathogenic. The most common finding was a CNV at 2p16.3 in 2 children (3%). Of the children with pathogenic CNVs, 3 (50%) had more than one CNV. One child had a previously diagnosed trisomy X. One child with normal CMA had further testing, and a genetic diagnosis of atypical Rett Syndrome was made. The primary management decisions based on the CMA test results included parent education, genetic counselling and prognosis clarification.

CONCLUSION
In a developmental paediatrics setting, the use of CMA testing for first-line etiologic assessment in children with developmental disorders obtains positive results in close to 10% of tested children. This is similar to previously published results. Approximately 1/6 tested children had results of uncertain significance which require further study over time.
THE USE OF PFA-100 IN PEDIATRICS IN THE INVESTIGATION OF HEMOSTATIC DISORDERS, A RETROSPECTIVE COHORT STUDY
Authors: Caron Andréane , Gélinas Marie-Christine 
Published: May 2018

Abstract

BACKGROUND
The screening of hemostatic disorders in paediatrics is challenging because often children have never undergone hemostatic challenges. The PFA-100 was introduced as an alternative to the in vivo bleeding time test and is now routinely used in the screening of these disorders. Numerous studies have assessed its limits and there remains uncertainty regarding its utility.

OBJECTIVES
The goal of our study was to describe the utilization of the PFA-100 in a tertiary paediatric center, to evaluate its accuracy and to determine the average cost generated by the investigation following an abnormal result.

DESIGN/METHODS
We did a retrospective descriptive study by reviewing the charts of 250 paediatric patients who had a PFA-100 done in our center over a one year period. Accuracy and reliability of the PFA-100 were calculated with a ROC curve (95% CI).

RESULTS
Of 225 patients included in our study, 99 (44%) PFA-100’s were done in a preoperative context, and in average, each patient had 1.52 PFA-100’s (range 1–6). Personal hemorrhagic diathesis was not described in 59 patients (26.2%). 91 patients (40.4%) had an abnormal PFA-100 result. Further investigation revealed no disorder in 55 patients (60.4%), von Willebrand disease in 20 patients (8.9%) and non-specific platelet function defects in 15 patients (6.7%). No severe platelet function defects were found in our study cohort. There was a high variability of the PFA-100 result in a same patient (coefficient of variation 15.8%). A higher cut-off value of 140 seconds for PFA-100 col_EPI (AUC 0,87) and 111 seconds for PFA-100 col_ADP (AUC 0,68) produced more accurate sensitivity (89% and 74%), specificity (78% and 63%) and positive (44% and 49%) and negative (97% and 84%) predictive values, compared to our center’s threshold of 130 seconds and 100 seconds respectively. The average cost per patient for the investigation following an abnormal PFA-100 was 434,92$ ± 232,66 (CI 95%).

CONCLUSION
PFA-100 was mainly used in a preoperative context in our study and patient history was often incomplete. The PFA-100 shows high sensitivity and negative predictive value making it a potentially good screening test however it is to be used with caution considering the high variability of results in a single patient.
VARICELLA-RELATED HOSPITALIZATIONS IN IMPACT CENTERS AFTER INTRODUCTION OF 1- AND 2-DOSE VARICELLA VACCINATION PROGRAMS BETWEEN 2000 AND 2015
Authors: Tan Ben , Bettinger Julie , McConnell Athena , Thibault Roseline , Jadavji Taj , Li Anita , Vaudry Wendy , Halperin Scott , Samson Heather 
Published: May 2018

Abstract

BACKGROUND
The Canadian Immunization Monitoring Program ACTive (IMPACT) conducts active surveillance for varicella-related hospitalizations in 12 paediatric tertiary care centres, starting Apr 1999.

OBJECTIVES
This study was to determine the hospitalization trends in relation to vaccine program introduction in the provinces, between 2000 and 2015.

DESIGN/METHODS
Demographic data of varicella cases from the 12 IMPACT centers were analysed. The cases were subdivided into three groups (A, B and C), combining provinces with approximately the same time periods at introduction of 1-dose and 2-dose vaccination programs (see results).

RESULTS
The mean number of hospitalizations per year declined during the 1-dose and 2-dose eras in each group of provinces, as follows:

CONCLUSION
Varicella hospitalizations declined by 63–77% but reached a plateau during the 1-dose vaccine era. There was a further decline to 81–89% of baseline in the two groups which instituted 2-dose vaccine programs in 2011–12, but too early to document any further decline in Group C, the provinces which initiated 2-dose programs in 2014–16. Introduction of 2-dose programs appear to have provided further benefit, after 1-dose programs in Canada.
TEN EPIQ STEPS TO IMPROVING CARE AND OUTCOMES IN RURAL TANZANIA
Authors: Ali Ismat , Mwaikasu Lusako , McMillan Doug , Aziz Khalid , Brenner Jennifer , Matovelo Dismas , Singhal Nalini 
Published: May 2018

Abstract

BACKGROUND
Maternal and child health (MCH) remains a priority globally and in Mwanza Region, Tanzania, where under-five mortality exceeds 100/1000 live births. Facility-based Quality Improvement (QI) is critical to enhancing MCH service delivery. The ‘Evidence-based Practice for Improving Quality (EPIQ)’ approach aims to equip clinical providers with basic QI understanding and skills. In Canada, EPIQ introduction has led to significant newborn intensive care improvements.

OBJECTIVES
To adapt, pilot and evaluate an EPIQ workshop for rural Tanzania.

DESIGN/METHODS
The 10-step EPIQ process is introduced through a practical, clinically-focused, hands-on workshop. A team of Canadian EPIQ experts with African partnership experience initially adjusted the EPIQ package for a Tanzanian pilot. They then facilitated a one day EPIQ training-of-trainers to QI-interested Tanzanian university faculty and health managers. The new facilitators then delivered the training to selected local health providers. The EPIQ training was evaluated through facilitator and provider (1) pre/post QI-focused knowledge tests, (2) pre/post QI confidence surveys and (3) post-workshop satisfaction surveys. Post training semi-structured group interviews also collected feedback on workshop content and format from facilitators. Written surveys and tests were analyzed using descriptive statistics and aggregate scores; semi-structured interview notes were reviewed for key themes, recommendations and representative quotations.

RESULTS
Workshop content including flipcharts, workbooks and locally-relevant cases were prepared. In September 2017, workshops were delivered to 16 facilitators and 29 providers in Mwanza. Post-workshop, overall knowledge scores increased by +7.6% (facilitators) and +2.1% (providers). Aggregate confidence survey scores (5-point Likert) increased for both groups by a median increase of 1 (20%). Participant workshop satisfaction scores averaged 4.7/5. Interviews suggested indicated content was perceived as very relevant however too heavy for allocated time; certain wording was too complex for the language setting. Participants reported that the small group and hands-on format encouraged skill development and EPIQ tools equipped for critical thinking and problem solving. It was strongly recommended to increase workshop length to two days.

CONCLUSION
A clinically-focused, participatory EPIQ training was feasible and well-received in this setting. Despite self-reported confidence increase, a lacking associated knowledge increase may reflect content too complex, limited workshop duration or poor knowledge test face validity. Future considerations should include revised content and/or knowledge testing tool, extended length, and post-workshop implementation follow-up.
EXPLORING EMPATHY IN PEDIATRICS RESIDENTS AT AN URBAN CHILDREN’S HOSPITAL IN CANADA
Authors: Rawal Surabhi , Nimmon Laura , Strahlendorf Caron 
Published: May 2018

Abstract

BACKGROUND
Empathy is fundamental to the physician-patient relationship, promoting both patient compliance and increased treatment efficacy. Studies attempting to quantify changes in empathy during residency are inconsistent in their findings; those examining paediatrics training specifically, are no more definitive. The mixed conclusions may stem from the use of self-reporting scores, which may fail to capture the essence of the effect.

OBJECTIVES
This study aimed to explore the state, and map a trajectory, of empathy in paediatrics residents, to identify factors influencing the learning and retention of empathy.

DESIGN/METHODS
This qualitative descriptive study was conducted at an urban children’s hospital in Canada. A constructivist phenomenological approach was used. Participants were recruited for semi-structured interviews via a purposive sampling strategy; thereafter, a thematic analysis was employed. Emerging themes were discussed at research meetings. Sufficiency was felt to be achieved after ten interviews.

RESULTS
Senior residents reported an overall increase in empathy, in part attributed to a better understanding of paediatric illnesses and greater perspective of the impact on families. There appeared to be a reconciliation with the changing shape of their empathy: managerial and administrative responsibilities could be performed empathically if patient priorities remained a central objective. Challenges to the retention of empathy correlated with published literature: time constraints, compassion fatigue and burnout with poor coping, and the hidden curriculum. Empathy was learned from role modelling by peers, preceptors, and other health care providers. Resident resilience, as a product of personal adversity, was protective against the loss of empathy; this could be considered in the postgraduate admissions process, and should be fostered with resident wellness strategies. Residents advocated for increased autonomy and patient ownership, and fuller exposure to longitudinal care, including the patient’s social context and home life, both of which could be considered as additions to residency training curricula to increase resident empathy.

CONCLUSION
Residents demonstrated an increase in empathy during training. Resident resilience is valuable in protecting empathy and could be considered in admissions processes. Longitudinal clinics and home visits should be considered as additions to residency training curricula.
VALIDITY OF PARENT-COMPLETED DEVELOPMENTAL SCREENING IN CHILDREN WITH NEW-ONSET EPILEPSY BELOW THE AGE OF 3
Authors: Barton Madelyn , Simard Marie-Noëlle , Reiter-Campeau Sandra , Lupien Genevieve , Lamothe Marie-Pierre , Chartrand Dominic , Saint-Louis Marie-Eve , Lortie Anne , Major Philippe , Diadori Paola , Birca Ala , Rossignol Elsa , Carmant Lionel 
Published: May 2018

Abstract

BACKGROUND
Infants with childhood-onset epilepsies, including epileptic encephalopathies, are at high risk of developmental challenges such as motor and language delays. There has been a growing focus on developmental screening instruments due to the association between delayed development and long-term adverse outcomes, including negative impacts on health-related quality of life, school achievement and social participation. Therefore, children with developmental delays should be referred as early as possible to rehabilitation services such as occupational, physical, or speech therapy. Developmental screening using standardized tools is recommended in order to identify the high-risk children that require additional developmental assessments. The Ages and Stages Questionnaires (ASQ), a parent-completed developmental screening tool, is one of the more cited and recommended developmental screening tools. However, its utility in children with early-onset epilepsy has yet to be validated.

OBJECTIVES
This study aimed to determine the validity of the ASQ for identifying children with new-onset epilepsy who require further professional developmental rehabilitation.

DESIGN/METHODS
Fifty infants (25 males) with seizure onset under 3 years of age were prospectively recruited. Parents completed the ASQ-3 before the first clinic appointment. The ASQ-3 evaluates 5 domains of development. An ASQ score below 2 standard deviations (SD) on any one of the domains was considered abnormal. Once completed, all infants were evaluated by a multidisciplinary team including neurologists, occupational therapists, and physical therapists to determine if they should be referred for further rehabilitation interventions. Accuracy of the ASQ was calculated in terms of sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV).

RESULTS
Mean age at the initial evaluation was 13.1 months (SD=8.22). Among the 50 infants, 36 (72%) received a score <-2 SD in at least one domain of the ASQ and 43 (86%) were referred for further rehabilitation services after the multidisciplinary assessment. The ASQ had a sensitivity of 81%, a specificity of 71%, a PPV of 93% and a NPV of 36% in identifying children with new-onset epilepsy who would require further rehabilitation services.

CONCLUSION
The ASQ, a well-known parent-completed developmental screening tool, when abnormal shows adequate validity for the identification of children with early-onset epilepsy who require developmental assessments and interventions by rehabilitation professionals. Our results also provide further evidence that development delay is the rule rather than the exception in infants with new onset epilepsy.
IMPLEMENTATION OF A PEDIATRIC PATIENT NAVIGATOR FOR CHILDREN WITH DEVELOPMENTAL OR MENTAL HEALTH CONCERNS
Authors: Suleman Shazeen , Milone Francine , Rollins Meaghen , Vojvoda Dorjana , Barozzino Tony 
Published: May 2018

Abstract

BACKGROUND
Nearly 1 in 5 Canadians will suffer from a mental health condition, with most of these diagnoses beginning in childhood and adolescence. Few children and youth with developmental and mental health conditions have adequate access to necessary clinical, community and social services. Patient navigator programs can bridge this gap by facilitating connections to social services, supporting family coping strategies and advocating for patient clinical services, yet there remain few programs in Canada for this patient population.

OBJECTIVES
To use a health behaviour change paradigm to develop and implement a paediatric patient navigator program for vulnerable children and youth living in a large urban centre in Canada

DESIGN/METHODS
A needs assessment was performed to identify navigation needs from the perspective of paediatric healthcare providers in an urban, inner-city district in Canada. Using these results, a referral and intake form were developed and pilot tested. To change provider behaviour with respect to utilization of the new navigation service, all providers, including paediatricians and allied health, participated in a workshop prior to implementation of the referral program and text reminders were posted throughout the clinic.

RESULTS
Patient navigation to access therapy services for children with developmental or mental health conditions, community services and assistance with completing funding information were identified as key services a paediatric patient navigator should offer. Participation in the workshop resulted in a significant increase in knowledge uptake for the role of the patient navigator and the referral process (p=0.01, 2-tailed T-test). 51 new referrals were received within one month of launching the paediatric patient navigation program, of which only 2 did not meet criteria

CONCLUSION
Patient navigation for children and youth with developmental and mental health diagnoses can be successfully implemented in an inner-city setting in a large urban centre. More research is needed to demonstrate the impact of patient navigation on patient health outcomes.
CANADIAN EARLY CAREER PAEDIATRICIANS ON THEIR TRANSITION TO PRACTICE EXPERIENCE
Authors: Rowan-Legg Anne 
Published: May 2018

Abstract

BACKGROUND
The Canadian Paediatric Society (CPS) is the national professional paediatric organization representing over 3000 child and youth health care providers. As future leaders, early career paediatricians (ECP, defined as those in their first 5 years of practice) are highly valued CPS members, and facilitating their active engagement is a key organizational priority. ECPs comprise 15% of the current CPS membership, and previous analysis has shown that this group’s membership rate drops by nearly one-third in the first 5 years of practice. This lack of engagement may be due in part to the intense amount of activity on multiple fronts during the transition to independent practice. We sought to better identify and understand these challenges, and determine how the CPS might better support this period of a paediatrician’s professional life.

OBJECTIVES
To better characterize the demographics of ECPs in Canada; to identify the challenges of transition to independent paediatric practice, and to inform future CPS initiatives to support them.

DESIGN/METHODS
Following iterative discussion, we created a 23-question survey with either closed-ended or free text responses. It was distributed, in English and French, via e-mail link to 481 Canadian ECPs across the country in September 2017. This group included both general and subspecialty paediatricians who had qualified for their Royal College certification in 2011 or later. Survey information was obtained by an online electronic tool (Survey Monkey). All responses remained confidential. Responses were collated, and descriptive statistics were used to analyze the data.

RESULTS
The survey response rate was 42% (200/481). 172/407 answered the English questionnaire, and 28/74 answered the French questionnaire. 68% self-identified as general paediatricians and 21% as subspecialists. Nearly three-quarters work in urban settings, with 35% at an academic/tertiary hospital. ECPs spend most of their working hours in a clinical setting (mean 80%), with less time in research and administration/leadership domains. Most (78%) were satisfied with their practice type and setting. Three-quarters reported good work-life balance. Identified challenges during the transition to practice included: financial and billing management; learning institutional processes and available resources; and achieving work-life balance. One third reported difficulty with continuing professional development.

CONCLUSION
These findings indicate that ECPs are more likely to be practising in urban settings and at academic centres. They describe some common challenges with transition to practice and would like the CPS to provide more practice management resources, mentorship, and career counseling. As a result, there is a clear opportunity for CPS to engage them in the organization, support their transition to practice, and offer accessible continuing professional education.
The impact of epidermal growth factor supernatant on pig performance and ileal microbiota1
Authors: Levesque Crystal L , Akhtar Nadeem , Huynh Evanna , Walk Carrie , Wilcock Pete , Zhang Zhengxiao , Dyce Paul W , de Lange Cornelius F M , Khafipour Ehsan , Li Julang 
Published: May 2018

Abstract
Weaning of pigs can lead to low-feed intake resulting in a lag in growth performance, reduced gut health, and diarrheal diseases. Epidermal growth factor (EGF), the most abundant growth factor in milk, increased weaned pig BW gain and feed efficiency in our previous work. It is believed that intestinal microbiota plays an important role in gut health and pig growth, but limited data are available on the impact of feed additives, such as EGF, on the microbial communities of the intestines. The objective of the study was to investigate if the positive influence of EGF supplementation on weight gain and gut health was related to differences in intestinal microbiota. To examine the efficacy of EGF, a 21-d animal trial was performed using 72 pigs (two equal blocks of 36 pigs with three barrows and three gilts/pen). Pigs were assigned to one of two dietary treatments at weaning (20 ± 2 d of age; n = 6 pens/treatment) balancing across treatment for litter, gender, and initial BW. Recombinant yeast supernatant containing EGF at 120 μg/kg BW/d and without EGF (control) was added to the feed for 21 d, followed by a common diet for 7 d. Pig performance was measured weekly and ileal digesta was collected at day 21 from six pigs/treatment for microbiome analysis. Pigs fed diets containing EGF fermentation supernatant had greater (P = 0.01) daily gain in week 3 and overall resulting in heavier (P = 0.029) BW at day 28, which was consistent to our previous finding. No difference in alpha-diversity (Chao1, Shanon, and Simpson indices) and beta-diversity (weighted and unweighted UniFrac distances) of ileal digesta microbiota between EGF supplemented and control pigs were observed. The relative abundances of bacterial taxa did not differ among treatment groups at the phylum level. The relative abundances of Corynebacterium (0.0 vs. 0.9%), Blautia (0.003 vs. 0.26%), and Coprococcus (0.0 vs. 0.05%) genera, and Rumminococcaceae family (0.001 vs. 0.08%) were decreased (P &lt; 0.05) in EGF group compared to control and were negatively correlated (P &lt; 0.05, r &gt; 0.60) with growth performance. Pathways related to detoxification and carbohydrate metabolism were differentially represented in the luminal bacterial populations. The improved growth of pigs supplemented with EGF supernatant produced by Pichia pastoris may be related to changes in functional capacity of the gut microbial populations. However, the impact on mucosa-associated or large intestinal communities is still unknown.