bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAFE TRANSITION TO ORAL ANTIBIOTIC THERAPY FOR PYELONEPHRITIS IN CHILDREN UNDER 2 MONTHS OF AGE: A RETROSPECTIVE STUDY
Authors: Lessard David-Alexandre , Tremblay Arnaud , Huard-Girard Thelma , Turcotte Jean-Francois 
Published: May 2018

Abstract

BACKGROUND
Febrile urinary tract infection (UTI) is a common cause of acute illness in paediatric medicine. Whereas oral antibiotic therapy (OAT) has become common practice in older children, the evidence supporting OAT in infants less than 2 months of age is still limited. The need for future research in the management strategies of UTIs in infants < 2 months of age has been acknowledged by the Canadian Paediatric Society.

OBJECTIVES
Describe the use of antibiotics in children < 2 months of age with a diagnosis of pyelonephritis at a Canadian tertiary care paediatric hospital and assess the safety of an early OAT switch in this population.

DESIGN/METHODS
A retrospective observational cohort study of infants < 2 months of age with a diagnosis of pyelonephritis based on 1) fever or systemic symptoms (lethargy, vomiting) and 2) a positive urine culture obtained from urinary catheterization. All children were seen between January 1st 2015 and July 30th 2017 at a single tertiary care centre. Infants were either hospitalized or followed in an outpatient day clinic. Chart review was performed and multiple variables were included in the analysis.

RESULTS
105 patients were included. Among those, 81 (77%) were boys. Most patients (87%) had Escherichia coli infection. Patients presented at a mean age of 33 ± 15 days and were admitted for 3.7 ± 2.7 days. Intravenous antibiotic therapy (IAT) – ampicillin and tobramycin or ampicillin and cefotaxime – were initially used in most patients (96%) with transition to OAT after a mean IAT duration of 3.9 days ± 2.4 days. A renal ultrasound was performed in all patients. In a subgroup of patients aged less than 30 days without bacteremia (44 patients), mean age at presentation was 19 ± 6 days. They were treated with IAT for 3.7 days ± 1.9 days before transition to OAT based on urine culture and resolution of fever. No patient was readmitted for a renal complication following discharge.

CONCLUSION
Early use of OAT following an initial IAT in infants < 2 months of age with a diagnosis of pyelonephritis appears to be a safe option. In infants < 30 days of age without bacteremia, our data suggests that early transition to OAT is not associated with worse outcomes.
IMPROVING COMMUNICATION IN THE NICU: PARENTAL PERCEPTIONS AND KNOWLEDGE ABOUT RESIDENT PHYSICIANS
Authors: Pellerin-Leblanc Amelie-Ann , Derynck Michael , Dow Kim 
Published: May 2018

Abstract

BACKGROUND
Residents play a pivotal role in patient care. Past research has demonstrated a lack of understanding of the roles of medical learners. It is therefore pertinent to assess patients and families’ views of the roles of residents, and how patient-resident interactions can alter their understanding. Furthermore, since patients are the ultimate stakeholders in the health care system, our goal should be to encourage their much deserved voice in the way we practice medicine, particularly in the neonatal intensive care unit (NICU) which is a challenging environment for families and learners.

OBJECTIVES
Our primary objective was to to better characterize parental knowledge and perception of resident’s roles. We also determined how medical learners can best identify themselves to family. Moreover, we explored the role of residents as effective communicators with parents. We also assessed parental satisfaction regarding their interactions with residents.

DESIGN/METHODS
Parents whose children were admitted to the NICU at our hospital for at least 24 hours were asked to complete a self-administered survey. Our cross-sectional survey, administered from January to December 2016, contained three types of questions: (1) neonatal and parental demographics; (2) parental knowledge and perceptions; and (3) parental preferences. Exclusion criteria included infant death, apprehension by child protection services and parents not fluent in French or English.

RESULTS
A total of 73 surveys were collected, for a final response rate of 38%. The majority (i.e., 81% of parents) reported having a resident involved in the care of their child. Significant findings included that level of education was shown to be directly correlated with knowledge of residents (r = 0.336, p = 0.006). Questions on parental knowledge revealed that 21% of respondents were not aware that residents are physicians. Most parents would like members of the medical team to identify their role. While 70 % of parents reported that residents effectively introduced themselves to them, 29% of desirous parents did not.

CONCLUSION
Most parents were familiar with the role of residents in this single-centre, prospective qualitative study. This survey highlights the importance of a clear introduction of the resident’s role to parents. Improved awareness of this factor may help residents improve their communication skills, and improve the family’s experience in the NICU.
USE OF SIMULATION-BASED SKILL ACQUISITION INSTRUCTION (SSAI) FOR MANUAL MASK VENTILATION (MMV) IMPROVES THE ABILITY OF NEONATAL RESUSCITATION PROGRAM (NRP) PROVIDERS TO DELIVER AND RETAIN EFFECTIVE MMV SKILLS
Authors: Amin Harish , Singhal Nalini , Beran Tanya , Kamaluddeen Majeeda , Amin Parthiv , Soraisham Amuchou , Brown Paul , Aziz Khalid 
Published: May 2018

Abstract

BACKGROUND
Ten percent of infants require resuscitation at birth. Effective manual mask ventilation (MMV) establishes functional residual capacity and delivers tidal volumes that promote gas exchange. A standard 4 to 6-hour NRP workshop does not ensure MMV competence. In fact, studies show that MMV is ineffective in 30 to 70% of simulated resuscitations. Effective MMV requires continual evaluation, and appropriate use of corrective steps when necessary. We hypothesize that simulation-based learning with video feedback improves MMV performance compared to traditional teaching.

OBJECTIVES
1. To assess MMV skills in NRP providers before and after simulation-based skill acquisition instruction (SSAI) using video-feedback.
2. To compare MMV performance between SSAI intervention and control groups.
3. To determine retention of MMV skills at 3 to 4 months post-intervention.

DESIGN/METHODS
In this randomized controlled study, perinatal care providers who had completed a standard NRP workshop were randomly assigned to an intervention (SSAI) or control group. All participants were assessed and videorecorded performing a standard MMV skill station using a NeoNatalie™ manikin. The intervention group reviewed their videorecordings and received instructor feedback on MMV performance. The control group reviewed the MMV chapter in the NRP textbook and received instructor feedback using a standard performance checklist without reviewing their videorecording. Feedback included observation of chest rise. Participants were assessed at 3 periods: (a) after first MMV station, (b) after immediate feedback, and (c) 3 to 4 months later.
Video recordings were scored by two investigators blinded to the randomization groups using a 13-item MMV skill scale. (0=not done; 1= done partly; 2 = done correctly) giving a maximum score of 26. We compared scores between the two groups.

RESULTS
Of the 91 participants, 46 were assigned to intervention and 45 to control group. The mean scores for the control group were: 20.1 (pre); 22.6 (post); and 21.6 (at 3–4 months post) compared to 22.1 (pre); 25.1 (post) and 24.7 (at 3–4 months post) for the intervention group.
Repeated measures analysis showed that there is an effect of group and time, with the intervention group performing and retaining skills better at follow up, Wilks’ lambda = 0.66, F(3,67) = 11.31, p < .001.

CONCLUSION
Use of SSAI with video-feedback in the teaching of MMV skills improves the ability of NRP providers to deliver and retain effective MMV in a manikin. NRP providers should be trained using SSAI. Video-feedback should be considered during NRP training. Video-feedback following real-life resuscitations should be studied for its potential benefit.
A PAN-CANADIAN STUDY ON THE COMPOUNDED MEDICINES MOST IN NEED OF COMMERCIALIZED ORAL PEDIATRIC FORMULATIONS
Authors: Gilpin Andrea , Autmizguine Julie , Allakhverdi Zoulifa , Tessier J-E , Giroux Denis , Lebel Denis , Litalien Catherine 
Published: May 2018

Abstract

BACKGROUND
A large number of drugs administered to children have no commercially available formulations. As a result, health care providers and parents manipulate dosage forms designed for adults. Although compounding is essential to increase access to medicines for children, it can result in adverse events or therapeutic failure. There is an urgent need to undertake a mapping of the needs for child-friendly medicines in Canada.

OBJECTIVES
To determine: 1) the most frequently compounded medicines in Canadian paediatric hospitals; 2) the challenges associated with drug compounding; and 3) medicines most in need of commercialized oral paediatric formulations.

DESIGN/METHODS
Sixteen Canadian paediatric academic hospitals were contacted to participate in a telephone survey including 12 open-, close-ended or Likert-scale questions.

RESULTS
Thirteen centers participated in the survey (81.3%). Fifty-three drugs were identified as most in need of a commercialized oral paediatric formulation. Of those, 12 were reported by ≥4 hospitals as a priority (Table). The most frequently reported compounding challenges were: lack of standardization, bad taste, lack of awareness of prescribers, stability of the formulation, and availability of compounding pharmacies.

CONCLUSION
This study highlights which drugs are most needed for paediatric oral formulations in Canada. For compounded medicines with paediatric formulations available in other countries we are currently assessing their adequacy and partnering with pharmaceutical industry to bring them to the Canadian market. As for those medicines without paediatric formulations in Canada or abroad we are looking for partners interested in developing such formulations. Furthermore, harmonized regulations and data-sharing should be pursued to facilitate access to child-friendly medicines.
HOUSING AND HEALTH: AN EXPLORATION OF HOUSING NEED IN CHILDREN WITH MEDICAL COMPLEXITY
Authors: Hounsell Kara Grace , Orkin Julia , Cohen Eyal , Soscia Joanna , Netten Kathy , Zahavi Arielle 
Published: May 2018

Abstract

BACKGROUND
Children with medical complexity (CMC), are defined by at least one chronic condition, functional limitation requiring technology support, multiple subspecialist involvement, and high healthcare utilization. A potentially significant social determinant that has yet to be examined in this population is that of “housing need.” According to the Canada Mortgage and Housing Corporation, “housing need” refers to housing that is crowded, unaffordable, or in need of major repairs. Given the known associations between housing and health, we hypothesize that housing need could be particularly relevant in CMC. Population-specific housing considerations may include in-home medical services, housing space, and disability accommodations.

OBJECTIVES
1) Determine the prevalence of housing need in families with CMC and 2) Explore the experience and meaning of housing need of caregivers of CMC.

DESIGN/METHODS
We conducted a mixed methods study using questionnaires and semi-structured interviews. Recruitment occurred through a tertiary paediatric hospital. Research ethics board approval was obtained. All participants were English-speaking primary caregivers of CMC living in the same household. Questionnaires were completed in person, by phone, or online via REDCap, a secure data collection application. Questionnaires explored safety, affordability, and accommodations and were analyzed using descriptive statistics. Following the questionnaire, participants were invited to be interviewed in person or by phone. Interview questions were developed iteratively and were analyzed using grounded theory.

RESULTS
Of the 354 eligible caregivers, 93 participated in the questionnaire. A total of 36 caregivers (40%) reported some difficulties paying for housing each month. In addition, 56 participants (62%) described unmet need for accommodations (i.e. a lift, toilet accommodations, etc.). A total of 65 participants (83%) reported that their child’s condition(s) affected their preferred housing location, while 55 participants (70.5%) felt it affected their preferred housing type. Of the fifteen interviews completed, several themes emerged including limited housing options for families with CMC and financial, physical, and mental health consequences of housing challenges. In addition, caregivers felt counseling was lacking on 1) safe evacuation and 2) housing requirements, such as space and equipment, as children age.

CONCLUSION
This is the first in-depth exploration of housing need amongst families of CMC. Challenges identified include affordability, disability accommodations, and restrictions on housing type and location due to children’s illnesses. Clinicians can support families of CMC by offering counseling on evacuation planning and common housing requirements for CMC.
Reevaluating Immunization Delays Post Red Blood Cell Transfusion
Authors: Zabeida Alexandra , Robitaille Nancy , Lebel Marc , Renaud Christian 
Published: May 2018

Abstract

BACKGROUND
Current Canadian guidelines recommend to delay the measles, mumps, rubella (MMR) and varicella live attenuated vaccines by 6 months following transfusion of unwashed red blood cells (RBC) due to potential interference by serum antibodies. Thus, patients chronically transfused with RBC commonly suffer from a delay or absence of MMR and varicella vaccination. Over the last decades, not only has RBC handling changed, but also fewer blood donors have had natural mumps, measles and rubella infections, resulting in lower blood antibody levels. The recommendations may thus be unfounded and outdated, and prevent valuable vaccination opportunities for children with frequent blood transfusions.

OBJECTIVES
The primary aim of this project was to determine MMR vaccination immunogenicity in patients chronically transfused with RBC.

DESIGN/METHODS
Medical charts were reviewed for vaccination and transfusion histories. MMR-specific antibodies were quantified in 25 paediatric patients who received both doses of the MMR vaccine at 12 and 18 months of age while they were on a chronic RBC transfusion program for sickle cell disease, B-thalassemia major, Diamond-Blackfan anemia or pyruvate kinase deficiency. There was no formal control group; long-term immunity rates in the literature are ≥90% for all MMR components.

RESULTS
Table 1 shows immunogenicity to MMR vaccine components. Delays between vaccination and serology testing averaged 5.9 years (0.3 to 15.8 years).

CONCLUSION
To the best of our knowledge, this is the first study designed to measure the effect of RBC transfusions on MMR vaccine immunogenicity. Although lower than the rates reported in the literature, the results suggest a high rate of immunogenicity to each component of the MMR vaccine in chronically transfused patients. Weighing the risks and benefits of disease prevention in a highly vulnerable population, a reevaluation of immunization delays post RBC transfusions is called for.
Evaluation of Vaso-Occlusive Crisis Management with Patient Controlled Analgesia in Children with Sickle Cell Disease Requiring Admission
Authors: Arbitre Claire , Trottier Evelyne D , Pastore Yves , Bailey Benoit , Robitaille Nancy , Kleiber Niina , Bergeron Marie Joelle Dore , Villeneuve Edith 
Published: May 2018

Abstract

BACKGROUND
Vaso-occlusive crisis (VOC) is one of the most distressing occurrences in patients with sickle cell disease (SCD). Patient controlled analgesia (PCA) is recommended by NIH and expert opinions favor its early use.

OBJECTIVES
We aim to review the use of PCA in patients with VOC and to evaluate if its early use is associated with faster pain control and reduced length of stay (LOS).

DESIGN/METHODS
This retrospective single center study included all paediatric patients admitted and treated with PCA for a severe VOC from 2010 to 2016. “Early” use was defined as start of PCA within 48 hours of arrival in the emergency department (ED) and “late” use after 48 hours. Time to reach adequate analgesia was defined as OUCHER, verbal scale or Faces Pain Scale < 5/10 obtained twice consecutively in a 4-hours interval. Time to reach adequate analgesia and LOS were compared between early-PCA and late-PCA groups.

RESULTS
A total of 46 patients presented 87 episodes of VOC treated with PCA during the study. Sixty-one episodes (70%) were treated with early-PCA and 26 (30%) with late-PCA. Both groups were comparable in terms of age (13.2 vs 12.8 years old), gender (55.8% female vs 57.7%), hemoglobin phenotype (80.3% HbSS vs 76.9%), but median pain score at admission was higher in early-PCA than in late-PCA (9/10 vs 7/10, median difference 1 (95% CI 0, 2). Early-PCA was associated with a median reduction in LOS of 3.15 days (95% CI 1.65, 4.82) (median early-PCA LOS 6.4 vs late-PCA 10.0 days). Time to reach analgesia could be evaluated only in a subset of patients (20 in early-PCA and 12 in late-PCA group). Although time to reach adequate analgesia tended to be shorter in the early-PCA group, it was not statistically different: median102.9 hours vs 123.5 hours, difference of 30.4 (95% CI -4.0,72.5). Side effects were observed during 29 (33.3%) PCA treatments (19/61 (31.2%) episodes in early-PCA, 10/26 (38.5%) in late-PCA group) among which 16 (18.6%) were significant adverse events. These were observed in 15 patients who required interventions: 2 desaturations requiring oxygen without intubation, 8 neurologic abnormalities (hallucinations, visual abnormalities, no stroke), 6 urinary retentions.

CONCLUSION
Early use of PCA for severe VOC was associated with a reduced length of hospital stay despite that these patients had higher pain score on admission. Prospective studies are needed to support these positive outcomes.
Utilizing Facebook and Automated Telephone Calls to Increase Adoption of a Local Smoke Alarm Installation Program
Authors: Frattaroli Shannon , Schulman Eric , McDonald Eileen M. , Omaki Elise C. , Shields Wendy C. , Jones Vanya , Brewer William 
Published: May 2018

Context:
Innovative strategies are needed to improve the prevalence of working smoke alarms in homes. To our knowledge, this is the first study to report on the effectiveness of Facebook advertising and automated telephone calls as population-level strategies to encourage an injury prevention behavior.

Objective:
We examine the effectiveness of Facebook advertising and automated telephone calls as strategies to enroll individuals in Baltimore City's Fire Department's free smoke alarm installation program.

Participants:
We directed our advertising efforts toward Facebook users eligible for the Baltimore City Fire Department's free smoke alarm installation program and all homes with a residential phone line included in Baltimore City's automated call system.

Design:
The Facebook campaign targeted Baltimore City residents 18 years of age and older. In total, an estimated 300 000 Facebook users met the eligibility criteria. Facebook advertisements were delivered to users' desktop and mobile device newsfeeds. A prerecorded message was sent to all residential landlines listed in the city's automated call system.

Results:
By the end of the campaign, the 3 advertisements generated 456 666 impressions reaching 130 264 Facebook users. Of the users reached, 4367 individuals (1.3%) clicked the advertisement. The automated call system included approximately 90 000 residential phone numbers. Participants attributed 25 smoke alarm installation requests to Facebook and 458 to the automated call.

Conclusion:
Facebook advertisements are a novel approach to promoting smoke alarms and appear to be effective in exposing individuals to injury prevention messages. However, converting Facebook message recipients to users of a smoke alarm installation program occurred infrequently in this study. Residents who participated in the smoke alarm installation program were more likely to cite the automated call as the impetus for their participation. Additional research is needed to understand the circumstances and strategies to effectively use the social networking site as a tool to convert passive users into active participants.
Identification of the Critical Nontechnical Skills for Surgeons Needed for High Performance in a Variable-resource Context (NOTSS-VRC)
Authors: Scott John W. , Lin Yihan , Ntakiyiruta Georges , Mutabazi Zeta , Davis William A. , Morris Megan A. , Smink Douglas S. , Riviello Robert , Yule Steven 
Published: May 2018

Objective:
To identify the critical nontechnical skills (NTS) required for high performance in variable-resource contexts (VRC).

Background:
As surgical training and capacity increase in low- and middle-income countries (LMICs), new strategies for improving surgical education and care in these settings are required. NTS are critical for high performance in surgery around the world. However, the essential NTS used by surgeons operating in LMICs to overcome the challenges specific to their contexts have never been described.

Method:
Using a constructivist grounded theory approach, 52 intraoperative team observations as well as 34 critical incident interviews with surgical providers (surgeons, anesthetists, and nurses) were performed at the 4 tertiary referral hospitals in Rwanda. Interview transcripts and field notes from observations were analyzed using line-by-line coding to identify emerging themes until thematic saturation was achieved.

Results:
Four skill categories of situation awareness, decision-making, communication/teamwork, and leadership emerged. This provided the framework for a contextually informed skills taxonomy consisting of 12 skill elements with examples of specific behaviors indicative of high performance. While the main skill categories were consistent with those encountered in high-income countries, the specific behaviors associated with these skills often focused on overcoming the frequently encountered variability in resources, staff, systems support, and language in this context.

Conclusion:
This is the first description of the critical nontechnical skills, and associated example behaviors, used by surgeons in a VRC to overcome common challenges to safe and effective surgical patient care. Improvements in the NTS used by surgeons operating in VRCs have the potential to improve surgical care delivery worldwide.