bluuebunny/crossref_metadata_2025_split huggingface dataset:
PREPAREDNESS OF CANADIAN PHYSICIAN OFFICES FOR PAEDIATRIC EMERGENCIES
Authors: Weeraratne Anushka , Jeong Dayae , Verma Suhrata , Atalla Marina , Hassan-Ali Mohammed , Kam April J 
Published: May 2018

Abstract

BACKGROUND
Studies in the US have demonstrated that many primary care staff and offices are inadequately prepared for paediatric emergencies. Although the Canadian Paediatric Society (CPS) recently reaffirmed their “Guidelines for Paediatric Emergency Equipment and Supplies for a Physician’s Office”, no evaluation has been made regarding the impact of publishing these recommendations, or on the state of preparedness for paediatric emergencies in family physician offices.

OBJECTIVES
The aim of this study was to evaluate awareness of and adherence of family physicians in Ontario to the CPS guidelines on preparedness for paediatric emergencies.

DESIGN/METHODS
We conducted a province-wide, cross-sectional survey of 749 randomly selected family physicians. Participants were asked to complete a 14-question survey regarding clinic characteristics, incidence of paediatric emergencies, and preparedness of the clinic in the case of a paediatric emergency. Ethics approval was obtained from the regional Ethics Review Board.

RESULTS
94 physicians responded to our survey (response rate of 13.1%). 68.1% of respondents reported seeing more than 10 children per week, and 59.6% and had experienced at least one paediatric emergency in the past year. The proportion of physicians reporting paediatric emergencies within the last year increased with the number of children seen - 37.9% of physicians who saw fewer than 10 children per week reported an emergency, compared to 100.0% of those who saw more than 40 children per week.
Only 4.3% respondents reported that they were unaware of the CPS guidelines on paediatric emergency preparedness. Although 85.1% of respondents were aware of the guidelines, only 10.6% of respondents had read them. Of the physicians who were aware of but had not read the guidelines, 2.5% engaged in mock code sessions, 27.8% were up-to-date on Paediatric Advanced Life Support (PALS), 1.3% had written protocols outlining safe transport of children to hospitals, and 41.8% stocked half or more of the recommended supplies. In comparison, of the physicians who had read the guidelines, 20.0% engaged in mock code sessions, 50.0% were up-to-date on PALS, 10.0% had written protocols, and 70.0% stocked half or more of the recommended supplies.

CONCLUSION
A large proportion of respondents had experienced at least one paediatric emergency in the past year, but were overall underprepared. There was a discrepancy between physicians who were aware of the CPS guidelines on emergency preparedness (85.1%), and those who have actually read them (10.6%), though offices with the latter were more adherent to the guidelines’ recommendations. It will be important for CPS to consider how to further advocate for paediatric emergency preparedness in clinics that see children regularly.
DEVELOPMENT OF A STANDARDIZED APPROACH FOR THE ASSESSMENT OF BOWEL AND BLADDER DYSFUNCTION IN COMMUNITY PAEDIATRICS
Authors: Wang Rebecca , Kanani Ronik , Mistry Niraj , Bardisi Yara El , Santos Joana Dos 
Published: May 2018

Abstract

BACKGROUND
Bowel and bladder dysfunction (BBD) is a common yet underdiagnosed paediatric condition that describes a constellation of lower urinary tract symptoms (LUTS) associated with constipation and/or encopresis. Many children with BBD have co-morbid neuropsychiatric symptoms (e.g., inattention, anxiety) and psychosocial stressors. Thus, clinical assessment of behavioural symptoms and social risk factors in this population is essential. However, there is no standardized approach for a comprehensive assessment of BBD.

OBJECTIVES
We aim to develop and evaluate physician and parent perceptions with 1) a standardized BBD history and physical intake form for physicians, and 2) a parent-reported intake form.

DESIGN/METHODS
From June to Oct 2017, a quality improvement study was conducted in the BBD network, an existing paediatric collaborative initiative consisting of 7 community sites with support of the paediatric urology division in a tertiary hospital. Based on literature review and expert opinions, a standardized intake form was developed for BBD assessment with targeted questions for LUTS, constipation, behavioural, dietary, and psychosocial history, along with a physical exam checklist for neurological red flags. Further, a shorter parent-reported intake questionnaire was developed to clarify patterns of dysfunctional voiding symptoms, dietary recall and stool history. Both forms underwent usability testing and iterative refinement. Prior to clinic, families of children referred for BBD were mailed an intake package for completion. During the clinic, physicians were asked to use the standardized intake form for new referrals. Afterwards, both physicians and parents were given anonymous surveys to evaluate their perceptions of the intake process.

RESULTS
A total of 8 physicians and 20 parents responded, with 60% of patients being between ages 4–10 and 55% male. Physicians found the standardized intake form to be a useful guide that reminded them to ask about specific urinary symptoms (88% of the time), constipation (75%), and psychosocial history (76%). The majority of physicians (75%) agreed they would use the intake form again and recommended its implementation. Further, parents responded positively by agreeing that the intake package was easy to complete (65%), felt included in care decisions (95%), and had questions answered appropriately (100%).

CONCLUSION
In assessment of BBD, a standardized intake form can help guide physicians to efficiently gather a comprehensive history, rule out red flags, and screen for psychosocial risk factors. With refinements, it can potentially help create a common clinical experience and empower more community paediatricians to manage BBD in the future.
UNDERSTANDING DISCHARGE COMMUNICATION BEHAVIOURS IN PEDIATRIC EMERGENCY CARE
Authors: Curran Janet , Bishop Andrea , Plint Amy 
Published: May 2018

Abstract

BACKGROUND
One of the most important transitions in the continuum of care for children is discharge to home. However, optimal discharge communication between healthcare providers and parents who present to the emergency department (ED) with their children is not well understood. Current research regarding discharge communication is equivocal and predominantly focused on evaluating different delivery formats or strategies with little attention given to communication behaviours or the context in which the communication occurs.

OBJECTIVES
The aim of this mixed methods study was to characterize the process and structure of discharge communication in a paediatric ED context.

DESIGN/METHODS
Real-time video observation methods were used in two academic paediatric EDs in Canada. Parents who presented with their child to the ED with one of six illness presentations, a Canadian Triage Acuity Score of 3 to 5, and English speaking, were eligible to participate. All ED physicians, learners, and clinical staff members were also eligible to participate. Provider-parent communication was analyzed using the Roter Interaction Analysis System (RIAS) to code each utterance. Parent comprehensive was evaluated using a follow-survey 72 hours after discharge.

RESULTS
A total of 106 unique ED visits involving six illness presentations: abdominal pain (n=23), asthma (n=6), bronchiolitis (n=4), diarrhea/vomiting (n=20), fever (n=27), and minor head injury (n=26) were video recorded. The average length of stay in the ED was 3 hours, with an average of three provider-parent interactions per visit. Interactions ranged in time from less than one minute to 29 minutes, with an average of six minutes per interaction. A total of 34,544 unique utterances were coded across all interactions. The majority of patient visits were first-time visits for the illness presentation (63.2%). Physicians most commonly gave medical information (22.9%) or asked close-ended medical questions (9.4%), whereas nurses most commonly gave orientation instructions (20.9%). Medical trainees were most likely to employ active listening techniques (e.g. back channels, 14.2%). Communication that included post-discharge instructions for parents comprised 8.5% of all utterances. Overall, providers infrequently assessed parental understanding of information (2.0%). Parent satisfaction with the amount of information communicated was generally high (89.6% agreed or strongly agreed).

CONCLUSION
This is the first discharge communication study to be conducted in a paediatric ED context using video observation methods. Provider-parent communication was predominantly characterized by the exchange of medical information, with little time devoted to adequately preparing parents to care for their child at home. Greater assessment of parental comprehension is needed to ensure that parents understand important instructions and know when to seek further care.
THE EFFECTIVENESS OF VIDEO DISCHARGE INSTRUCTIONS FOR ACUTE OTITIS MEDIA IN CHILDREN: A RANDOMIZED CONTROLLED TRIAL
Authors: Belisle Sheena , Dobrin Andrei , Elsie Sharlene , Ali Samina , Brahmbhatt Shaily , Kumar Kriti , Jasani Hardika , Ferlisi Frank , Bertram Kaitlyn , Poonai Naveen 
Published: May 2018

Abstract

BACKGROUND
Pain, the most identifiable feature of acute otitis media (AOM), is undertreated with 30% of children ≤ 2 years experiencing pain, fever, or both for up to 7 days, highlighting the importance of effective caregiver education.

OBJECTIVES
We sought to determine if video discharge instructions were associated with improved symptomatology, functional outcomes, and knowledge compared to a paper handout.

DESIGN/METHODS
We conducted a randomized controlled superiority trial comparing video discharge instructions (Easy Sketch Pro3TM) on management of pain and fever to a paper handout detailing the same. We included primary caregivers of children 6 months to 5 years presenting to the emergency department (ED) with a clinical diagnosis of AOM. The primary outcome was symptomatology using the Acute Otitis Media Severity of Symptom (AOM SOS) score between 48 and 72 hours. The 7-item self-report AOM-SOS is scored from 0 to 13 with a higher score indicating more symptomatology. Secondary outcomes included knowledge gain using a 10-item survey, days of daycare/school/work missed, and recidivism.

RESULTS
A total of 219 caregivers were randomized and 149 completed the 72-hour follow-up (72 paper and 77 video). Participants were primarily mothers (175/219, 79.9%); 136/219 (62.1%) completed post-secondary education and 147/219 (67.1%) had previously cared for a child with AOM. Children included 107/219 (48.6%) females with an overall mean (SD) age of 2.9 (2.8) years. Caregivers did not offer analgesia to 41/219 (18.7%) of children. The median (IQR) AOM-SOS score in the video group was significantly lower than the paper group, even after adjusting for pre-intervention AOM-SOS and medication (analgesics and antibiotics) given by caregivers [8 (7,11) versus 10 (7,13), respectively, p = 0.004]. There were no significant differences between video and paper in the mean (SD) number of correct answers given on the post-intervention survey [9.2 (1.3) versus 8.8 (1.8), respectively, p = 0.07], mean (SD) number of children that returned to a health provider [8/77 versus 10/72, respectively, p = 0.49), mean (SD) number of daycare/school missed by child [1.2 (1.5) versus 1.1 (2.1), respectively, p = 0.62, mean (SD) number of work missed by caregiver [0.5 (1) versus 0.8 (2), respectively, p = 0.05].

CONCLUSION
Children of caregivers with AOM who received a five-minute video detailing the identification and management of pain and fever experienced less symptomatology compared to a paper handout. Our findings suggest that video discharge instructions in the ED are effective for caregiver education and should be used routinely.
KINDERGARTEN-AGE QUALITY OF LIFE OUTCOMES AFTER LIVER TRANSPLANTATION AT <6 YEARS
Authors: Wong Kerry , Joffe Ari R , Yap Jason , Acton Bryan , Dinu Irina , Moez Elham Khodayari , Robertson Charlene MT 
Published: May 2018

Abstract

BACKGROUND
Given the improved mortality after paediatric liver transplantation, health related quality of life (HRQL) is an important outcome measure and provides valuable information for families.

OBJECTIVES
To determine the HRQL of kindergarten-age children who have undergone liver transplantation at age <6 years old.

DESIGN/METHODS
Between 1999–2014, all paediatric liver transplant recipients at our center were enrolled in this ethics board approved, longitudinal inception-cohort study. Following informed consent, HRQL was measured using the parent completed Pediatric Quality of Life Inventory, version 4.0 (PedsQL). The association between pre-transplant, transplant, and post-transplant variables and HRQL was examined using multiple regression analyses. Scores were compared to normative scores for HRQL in 8700 children [total PedsQL 82.2 (15.5), psychosocial summary 81.2 (15.3), and physical summary 84.0 (19.7)] and to scores for 130 children with surgical congenital heart disease from early infancy [81.1 (13.9), 77.5 (16.4), and 86.4 (15.3) respectively].

RESULTS
78 liver transplants for children <6 years of age were performed; 69 patients (88.5%) survived, and all (100%) were assessed at 55.4 (7.2) months of age: 38 with biliary atresia, 11 with acute liver failure, 11 with cholestasis, and 9 with metabolic disease. The mean total PedsQL was 75.6 (SD=15.6), psychosocial summary 72 (15.9) [a composite of emotional functioning 73.8 (16.4), social functioning 74.6 (19.2), and school functioning 70.6 (19.1)], and physical summary 78.2 (20.9). These composite scores were all statistically significantly different from population norms (p<0.001, <0.001, 0.026 respectively) and surgical congenital heart disease patients (p=0.015, 0.029, 0.005). The proportion having a score >1 (expected 15.9%) and >2 (expected 2.27%) SD below population norms were: total PedsQL 20.6% and 11.8%, psychosocial summary 32.3% and 11.3%, and physical summary 19.1% and 7.4%. Having a wait-list status 1 on the Canadian System of Classification was associated with higher total PedsQL (Effect size 9, 95%CI 2, 16; p=0.018) and physical summary (Effect size 15, 95%CI 16, 79; p=.004). None of the perioperative variables were predictive for psychosocial summary. Variables not associated with PedsQL included metabolic disease, PELD score, growth failure, any post-operative severe complication, age at transplant, weight at transplant, socioeconomic status, and year of transplant.

CONCLUSION
HRQL after liver transplantation is lower than population norms and congenital heart disease patients. More research is needed to determine why HRQL is low in order to improve the lives of these children.
IMPACT OF HIGH LEVELS OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON CARDIAC OUTPUT IN PRETERM NEONATES: A PROSPECTIVE PHYSIOLOGICAL STUDY
Authors: Mukerji Amit , Muzafar Wahab Abdul Gani , Mitra Souvik , Mondal Tapas , Paterson Debie , Beck Jennifer , Fusch Christoph 
Published: May 2018

Abstract

BACKGROUND
Many NICUs employ high (>8 cmH2O) positive end-expiratory pressures (PEEP) on nasal continuous positive airway pressure (NCPAP) to prevent intubation and associated ventilator-induced lung injury, despite limited safety/efficacy data.

OBJECTIVES
This study sought to evaluate the physiological impact of high NCPAP PEEP.

DESIGN/METHODS
Fifteen preterm neonates at postmenstrual age ≥32 weeks (without congenital anomalies or acute intercurrent illness) on NCPAP PEEP of 5 cmH2O were enrolled. PEEP was increased by 2 cmH2O increments until 13 cmH2O. At each increment, following 5 minutes washout, cardiac output (aortic velocity-time integral x heart rate) and cardiorespiratory parameters including blood pressure, heart rate, respiratory rate were measured over 10 minutes. Predefined cut-off values for changes in cardiorespiratory parameters were used as termination criteria. Data are presented as mean (SD), and were compared using one-way ANOVA.

RESULTS
The mean GA, age at study, and weight of subjects were 27.4 (2.6) weeks, 58.5 (35.5) days, and 2.3 (0.6) kg, respectively. Cardiac output (mL/kg/min) at PEEPs of 5, 7, 9, 11, and 13 cmH2O were not different at 295 (75), 290 (66), 281 (69), 286 (73), and 292 (58), respectively (P=0.986), as shown in Figure 1a. Importantly there were also no differences in either aortic velocity-time integral or heart rate over these PEEP ranges (Figures 1b and 1c). There were no significant differences in cardiorespiratory parameters; no subjects met cut-off criteria. Data collection was terminated in 2 subjects after PEEP 9 cmH2O due to lung over-distension subjectively noted on echocardiogram.

CONCLUSION
High levels of NCPAP PEEP were well tolerated for short durations. Further physiological and clinical research is required on safety/efficacy in neonates with more severe lung disease, as well as its impact over longer durations.
CEREBRAL OXYGENATION AND PERIPHERAL OXIMETRY IN EXTREMELY PRETERM INFANTS WITH PULMONARY AND/OR CEREBRAL INTRAVENTRICULAR HEMORRHAGE IN THE FIRST 72 HOURS OF LIFE
Authors: Beausoleil Thierry , Janaillac Marie , Barrington Keith , Raboisson Marie-Josée , Karam Oliver , Lapointe Anie , Dehaes Mathieu 
Published: May 2018

Abstract

BACKGROUND
Extremely premature infants born <28 weeks of gestation are at higher risk of pulmonary (PH) and cerebral intraventricular (IVH) hemorrhage due to immature cardiovascular and transitioning physiology. Non-invasive monitoring has the potential to detect early abnormal circulation.

OBJECTIVES
To explore time-frequency relationships between cerebral oxygenation and peripheral oximetry.

DESIGN/METHODS
Near infrared spectroscopy cerebral regional haemoglobin oxygen saturation (CrSO2), preductal peripheral perfusion index (PI), heart rate (HR), capillary oxygen saturation (SpO2), and blood pressure (BP) were monitored in the first 72h of life. Patients were grouped in infants with PH and/or IVH (n=8) and controls (n=10). Signals were decomposed in wavelets allowing the analysis of localized variations of power. This approach allowed to quantify the common power and determine the duration of significant cross-correlation, phase and coherence between each pair of signals. Groups were compared with Wilcoxon tests.

RESULTS
Figure 1 shows an example of CrSO2 and PI, and their cross-correlation, phase (semblance) and coherence in a control (left column) and a PH-IVH patient (right column). Durations of significant cross-correlation between CrSO2 and HR (p<0.01), and CrSO2 and SpO2 (p=0.02) were significantly lower in PH-IVH infants compared to controls. The duration of significant anti-phase between CrSO2 and SpO2 (p=0.01) and the duration of significant coherence between PI and BP (p=0.03) were also significantly lower in PH-IVH infants compared to controls. These differences may indicate a disruption in auto-regulation, which is currently incompletely understood in this population.

CONCLUSION
This study is the first to apply time-frequency analysis to simultaneous NIRS and preductal peripheral oximetry in extremely preterm infants early in life. Significantly lower durations of cross-correlation (CrSO2 with HR and SpO2), anti-phase (CrSO2, SpO2) and coherence (PI, BP) in PH-IVH patients may reflect early abnormal circulation. Our results show the potential of non-invasive monitoring to identify premature infants at-risk of early PH-IVH.
DOES THE TIMING OF MEDICAL TREATMENT OF PATENT DUCTUS ARTERIOSUS (PDA) HAVE AN IMPACT ON THE SUCCESS OF TREATMENT IN PRETERM INFANTS?
Authors: Kaur Sharandeep , Stritzke Amelie , Soraisham Amuchou 
Published: May 2018

Abstract

BACKGROUND
Hemodynamically significant patent ductus arteriosus (hsPDA) is the most common cardiovascular problem of prematurity often treated with nonsteroidal anti-inflammatory drugs (NSAIDs-indomethacin and ibuprofen). There is limited data on the effect of postmenstrual age (PMA) at the time of start of treatment on response rates to NSAIDs in preterm infants with hsPDA.

OBJECTIVES
The objective of our study was to examine the effect of PMA at the start of treatment on response to NSAIDs in hsPDA.

DESIGN/METHODS
In this retrospective cohort study, we included infants with gestational age (GA) ≤ 32 weeks admitted to a tertiary NICU between January 2014 and December 2016, who had received one or more doses of NSAIDs for the treatment of hsPDA. Positive response (responders) to NSAIDs was considered if post treatment echocardiogram showed that PDA was either closed or small, and did not require further medical or surgical treatment. We compared baseline characteristics between responders and non-responders using univariate and multivariable logistic regression.

RESULTS
A total of 183 infants received 257 courses (one, two and three courses in 183, 62 and 12 neonates respectively) of NSAIDs. Positive response rate was overall 60%, and 66%, 48%, and 50% for the first, second, and third course respectively. The baseline characteristics were comparable between responders and non-responders except for higher GA, birth weight (BW), and earlier (<14 days of life) start of NSAIDs in responders. After adjusting for BW, Apgar score and gender, GA at birth but not the PMA, was associated with positive response to NSAIDs (aOR 1.24, 95% CI 1.07, 1.42 for GA; aOR 0.92, 95% CI 0.79, 1.07 for PMA). Early NSAIDs treatment was associated with increased odds of PDA closure (aOR 1.95; 95% CI 1.00–3.8).

CONCLUSION
Gestational age is the strongest predictor for response to NSAIDs in hs-PDA and PMA at treatment does not affect efficacy of NSAIDs.