bluuebunny/crossref_metadata_2025_split huggingface dataset:
31 Impact of the amount of intravenous glucose administration on hospitalization for acute gastroenteritis in a paediatric emergency department
Authors: Santamaria Christina , Peloquin Fannie , Mousseau Sarah , Gravel Jocelyn 
Published: October 2024

Abstract

Background
In case of failure of oral rehydration, children with acute gastroenteritis can be hydrated using intravenous (IV) solution. The choice of the intravenous solution itself (solutions containing dextrose versus crystalloids alone) and the glucose quantities to administer are not well established.

Objectives
The main objective of this study was to evaluate the impact of the amount of intravenous glucose provided to children treated for acute gastroenteritis on hospitalizations. Other objectives were to evaluate practice variation regarding the amount of glucose and liquid provided for IV rehydration in a paediatric emergency department (ED).

Design/Methods
We conducted a retrospective cohort study from 2019-2022 in a Canadian paediatric ED. We included children with acute gastroenteritis undergoing IV rehydration. Patient with hypoglycemia, metabolic disease or diabetes were excluded. The IV glucose administered during the initial four hours of rehydration was quantified. The primary outcome was hospitalization and return visit in the following seven days was a secondary outcome. 10% of the charts were evaluated in duplicate to assess inter-rater reliability. We examined glucose distribution at one and four hours, and utilized multiple logistic regression to relate glucose amounts with hospitalization and second visit, accounting for age, weight, bicarbonate levels, ondansetron use, and amount of liquid infused. It was estimated that the evaluation of 250 cases would have at least 50 admissions.

Results
Among 6,939 children evaluated for potential acute gastroenteritis, 250 met our inclusion/exclusion criteria. All variables included in the analysis had excellent inter-rater reliability. Notable variations existed in glucose quantities provided, both at one hour (first quartile: 87 mg/Kg; third quartile: 294 mg/Kg) and four hours (first quartile: 681 mg/Kg; third quartile: 1174 mg/kg) of rehydration. Multiple logistic regression showed a greater hospitalization risk with smaller amount of glucose administered during the initial hour (OR for each 100mg/kg increment: 0.60; 95%CI: 0.42-0.84) and four hours (OR: 0.76; 95%CI: 0.63-0.91) of rehydration. Moreover, children who received more dextrose during the first hour of rehydration were at lower risk of return visit (OR for each 100mg/kg increment: 0.52; 95%CI: 0.35-0.78), as well as during the first four hours (OR for each 100 mg/kg increment: 0.83; 95%CI: 0.73-0.94).

Conclusion
There was a wide practice variation in intravenous glucose provided to children with acute gastroenteritis. In this population, higher intravenous glucose amount was associated to a lower risk of hospitalization and lower risk of return visit.
32 A randomized controlled trial of virtual reality-based distraction for intravenous cannulation-related distress in children
Authors: Hudson Summer , Rajagopal Manasi , Gourlay Katie , Hartling Lisa , Stinson Jennifer , Ma Keon , Vandermeer Ben , Schreiner Kurt , Ali Samina 
Published: October 2024

Abstract

Background
Children commonly experience under-treated pain and distress related to medical procedures, such as intravenous insertions (IVI), leading to both short- and long-term negative consequences for patients and their caregivers. Virtual reality (VR) has emerged as a promising tool to ameliorate procedure-related distress in the paediatric healthcare setting; however, existing evidence has largely employed custom VR software, which can be expensive and inaccessible. As such, we aimed to characterize whether commercially available VR applications are effective in reducing children’s procedure-related distress.

Objectives
To assess the effectiveness of commercially available VR-based distraction when added to standard of care (SOC, which included topical anesthetic cream), in reducing distress for children undergoing IVI in the paediatric emergency department (PED).

Design/Methods
Children aged 6 to 17 years requiring IVI in a Canadian PED were recruited for a two-arm randomized controlled trial. The primary outcome was child distress, measured using the Observational Scale of Behavioural Distress – Revised (OSBD-R, score range 0-23.5). Secondary outcomes included child pain intensity (measured with the Faces Pain Scale-Revised, score range 0-10) and caregiver anxiety [measured by the State-Trait Anxiety Inventory-State (STAI-S), score range 20-80] during the procedure. Trial registration number: NCT04291404C.

Results
82 children and their caregivers were included. 41 children received VR distraction in addition to SOC (mean age 10.8 years, SD 3.0), while 41 children received SOC alone (mean age 11.3 years, SD 2.8). There was no significant difference between OSBD-R-measured distress in the VR arm (mean 1.05, SD 1.52) compared to the SOC arm (mean 0.71, SD 1.40) (p = 0.08). There was no significant reduction in procedural pain intensity in the VR group (mean 4.20,SD 3.10) compared to the SOC group (mean 4.10, SD 3.20) (p = 0.85). There was no difference in caregiver STAI-S score immediately following IVI in the VR arm (mean 32.3, SD 11.3) versus the SOC arm (mean 32.3, SD 11.9) (p = 0.86).

Conclusion
VR distraction therapy employing commercially available software was not associated with reduction in procedural distress or pain, above that provided with SOC in the PED, for children undergoing IVI. This result highlights the need for more accessible custom VR distraction software, created to meet the unique psychological needs of children undergoing medical procedures. Further study is needed to directly compare custom versus commercially available VR software for this application.
48 Evaluation without representation: Paediatric residents perspectives on CBME
Authors: Anzinger Harrison , Schrewe Brett 
Published: October 2024

Abstract

Background
Paediatrics transitioned in 2021 to Competence By Design (CBD), a postgraduate education model spearheaded by the Royal College of Physicians and Surgeons of Canada (Royal College). CBD replaced a time-based training system with one based on competencies demonstrated through regular observations of trainee performance. Although intended to be learner-centered, resident voices have been underrepresented in CBD’s design.

Objectives
We sought to (1) understand how paediatric residents perceived CBD as impacting their education and evaluation, and (2) explore their ideas to improve its implementation.

Design/Methods
We compared three Canadian postgraduate paediatric residency programs. First, we reviewed Royal College and program-specific documents regarding CBD to understand local and national priorities for its implementation. Program directors and local education leads were then interviewed to understand local priorities and implementation practices at these programs. Lastly, we conducted interviews with paediatric residents that began residency the year that CBD was launched. We used reflexive, inductive analysis to analyze their perspectives on how CBD has affected their education and develop learner-informed recommendations for improvement.

Results
We interviewed six program directors and CBD leads. Identified programmatic benefits included improved trainee surveillance, facilitated curriculum change, and competency committees. Challenges included untrained faculty, workplace-based assessment tensions, and administrative burden on residents and staff. Subsequent interviews with ten paediatric residents demonstrated CBD as having limited benefit to their education, leading to a checklist mentality of EPA completion and disengagement with the CBD system. These perceptions were influenced by (1) administrative burden, (2) poor quality feedback from disengaged staff with limited coaching experience, and (3) a lack of collaborative communication between the residents, their programs, and the Royal College. Residents suggested improvements, including: decreasing the number of assessments to alleviate time burden on both residents and faculty; implementing formal coaching instruction for residents and staff; and improving dialogue between Royal College, competency committees, and residents and physician evaluators to build buy-in with the system and facilitate continuing process improvement.

Conclusion
If we are to effectively adapt postgraduate educational systems to equip learners with the skills to meet the needs of the societies they serve, centering resident voices in curricular revision is paramount to maximize learner buy-in, minimize unintended administrative burden, and guide the development of necessary institutional supports (e.g., formal coaching) to ensure successful system transformation.
49 Effects of numeracy and literacy on glycemic control and self-perceived efficacy in youth with type 1 diabetes in Haiti
Authors: Leduc Bertrand , Von Oettingen Julia Elisabeth , Duperval Regina , Altenor Ketly , Joseph Mysterline 
Published: October 2024

Abstract

Background
The management of type 1 diabetes (T1D) in low-resource settings remains a challenge in the context of unfavourable social determinants of health. The effects of literacy and numeracy on glycemic control and self-perceived efficacy in youth living with T1D in low-resource settings have been insufficiently investigated.

Objectives
We described literacy and numeracy in Haitian youth with T1D and their caregivers and we evaluated their association with hemoglobin A1c (HbA1c) and perceived diabetes management self-efficacy.

Design/Methods
We conducted a cross-sectional cohort study of youth with T1D treated at the Montrouis clinic in Haiti, between June to December 2017. Inclusion criteria were a diagnosis of T1D at age 0-25 years and at least one parent of Haitian ancestry. One principal caregiver of each youth was also included. Exclusion criteria were inability of informed consent and declined home visit. The study was approved by our Institution Research Ethics Board. Data collection included demographics, clinical data, numeracy questionnaire adapted to the population and the standardized self-efficacy 8-item Perceived Diabetes Self-Management Scale (PDSMS). We used univariate and multivariate linear regression models to evaluate predictors of HbA1c and PDSMS scores.

Results
We included 85 patients (60% female) and 73 caregivers. Median age at diagnosis and diabetes duration were 14.3 and 3.1 years, respectively. Over 90% of patients had suboptimal (HbA1c &gt;7.0%), poor (HbA1c &gt;9%) or very poor (HbA1c &gt;12%) glycemic control. 76 patients (90.5%) self-reported being able to read, 78 (91.8%) to write and 84 (98.8%) to count. Mothers’ and fathers’ median education years were 7.0 and 11, respectively. 54 parents (74.0%) self-reported being able to read and write. Normalized to 100%, median patient numeracy score was 75.0% and the mean PDSMS score was 65.9%. In univariate models, lower HbA1c was predicted by younger age (p=0.013), but not by gender, diabetes duration, numeracy score, mother’s education or PDSMS score. Higher PDSMS score was predicted by higher numeracy scores (p=0.003), marginally by sex (p=0.057), but not by age, diabetes duration, or mother’s education; in a multivariate model adjusted for age, sex and diabetes duration, higher numeracy remained significant (p=0.006).

Conclusion
In youth with T1D in Haiti who have ubiquitously poor glycemic control and suboptimal family literacy and numeracy, numeracy is a predictor of self-perceived efficacy of T1D. Further public health interventions addressing numeracy in youth living with T1D in low-resource settings are advised.
57 Resident education in the NICU: A curriculum innovation project
Authors: Ediger Krystyna , Cormier Sylvie 
Published: October 2024

Abstract

Background
For paediatrics residents, much of newborn care is learned during Neonatal Intensive Care Unit (NICU) rotations. However, the NICU is a high-stress and specialized learning environment. Today’s residents often have less NICU exposure during their training than in the past, leading to concerns from trainees that they are inadequately prepared for neonatal care and resuscitation upon graduation.

Objectives
We aimed to develop, implement and evaluate a paediatric residency NICU curriculum aimed to augment and improve learning on rotation.

Design/Methods
We utilized Kern’s Six Step Approach for Curriculum Development. Step 1: We identified that our paediatric residents consistently expressed dissatisfaction with the quality and quantity of learning opportunities on their NICU rotations. Step 2: A collaborative working group of residents, paediatricians, and neonatologists identified learning needs. Step 3: Needs were mapped to specific general paediatrics educational objectives within the Royal College Competency Based Medical Education (CBME) curriculum. Step 4: Suitable learning strategies were selected including simulation, procedural skill training, embedded time with the neonatal resuscitation team, and lunch and learn seminars. Steps 5 and 6: The curriculum was piloted during the 2021-2022 academic year and resident reactions evaluated.

Results
The detailed curriculum is shown in Table 1. At the start of each NICU rotation, all paediatrics residents on rotation attended a half-day simulation based “boot-camp” consisting of a didactic Neonatal Resuscitation Program (NRP) refresher course, relevant procedural skills stations (intubation, UVC placement, needle thoracocentesis), and simulated neonatal resuscitation scenarios. Junior residents were scheduled for protected time to attend deliveries with a dedicated multidisciplinary resuscitation team to ensure familiarity and begin to solidify skills. Learning was further augmented by weekly, resident-led lunch and learn sessions on topics mapped to level of training. To evaluate this curriculum, resident satisfaction was assessed using surveys post bootcamp and at the end of their rotation. Overall, the curriculum was well received. Bootcamp was the highest rated element; 96% of residents agreed or strongly agreed that the session was useful for their education (Figure 1). Post curriculum implementation, there was significant improvement in resident NICU rotation feedback; residents expressed that the NICU learning environment and resident experience has improved.

Conclusion
We successfully implemented a NICU curriculum for paediatrics residents, with high satisfaction ratings and improved overall rotation feedback. This program shows promise in addressing a long standing educational gap. More research is needed to investigate whether it leads to improved competency in practice.
69 Urinary tract infections in preterm infants: Review in two Canadian tertiary centers
Authors: Nguyen Bao-Nghi , Kuan Mimi , Balay Celine , Shen Ye , Richter Lindsay , Lisonkova Sarka , Wong Jonathan , Ting Joseph 
Published: October 2024

Abstract

Background
Urinary tract infections (UTI) in premature infants are commonly seen in the neonatal intensive care unit (NICU). The reported prevalence of UTI in this population ranges from 1.9-12.2% due to the lack of standardized criteria for UTI among infants less than two months of age. Enterococcus and Enterobacteriaceae are well known to cause UTI and their resistance pattern has been reported to be rising in the neonatal nosocomial infections worldwide.

Objectives
To describe the epidemiology, microbiology, and antimicrobial treatment for UTI in premature infants based on different diagnostic criteria.

Design/Methods
This retrospective study (2019-2022) included infants born at &lt;33 weeks of gestational age (GA) with positive urine cultures and ≥5 days of antimicrobials treatment. We collected data from two tertiary level NICUs in Canada, including demographics, microbial susceptibility patterns, urinalysis and imaging results, and antibiotic treatment.

Results
We identified 43 infants managed as UTI based on physicians’ discretions. The median GA at birth was 26-27 weeks, while the median onset of first UTI ranged 39-80 days, with male predominance [Table 2]. Mixed growth of organisms constituted 21-42% of cases of UTI [Table 1]. Among UTI cases with only single growth organism, we found 53.5% and 18.6% cases fulfilled UTI diagnostic criteria based on the concentration of colony forming units (CFU) of &gt;104/mL or &gt;107/L and &gt;105/mL or &gt;108/L, respectively [Table 1]. Of these cases, 67.4% of infants had urinalysis sent with the culture, and the higher the concentration of CFU, the more likely the samples showed positive nitrites on urinalysis, with 100% correlation among those with CFU &gt;105/mL or &gt;108/L. [Table 1] The most common pathogens were Enterococcus species, E.Coli, Klebsiella species, Citrobacter species and Enterobacter cloacae complex [Table 2]. Among gram negative bacilli (E. Coli and Klebsiella species), greater than 42-80% were resistant to 3rd generation cephalosporins (3GC). We did not identify any vancomycin-resistant Enterococcus strains. Median duration of antimicrobial treatment ranged from 8-13 days, depending on the diagnostic criteria applied. At least 10% of infants with UTI showed abnormalities on kidney ultrasound [Table 2].

Conclusion
There exists a large variation in UTI prevalence according to different diagnostic criteria. Abnormal urinalysis with presence of nitrites were frequently associated with UTI of high CFU count. High resistance to 3GC among gram negative bacilli was concerning and carried an impact on the appropriate empirical treatment choice.
74 Reducing unplanned extubations in a level 3 neonatal intensive care unit - the nuts and bolts of UE bundle implementation
Authors: Law Brenda Hiu Yan , Godbout Vanessa 
Published: October 2024

Abstract

Background
Unplanned extubations (UEs) are preventable adverse events that may lead to short term consequences (e.g. cardiopulmonary collapse) and long term sequelae (e.g. acquired airway injury, brain injury) for patients admitted to the Neonatal Intensive Care Unit (NICU). UE prevention care bundles have been demonstrated to reduce UE rates in NICUs; however, implementation of bundle elements is unit dependent.

Objectives
To describe the work of a UE Prevention Team in a Level 3 NICU with rising UE rates despite implementation of UE prevention bundle per Children’s Hospital Solutions for Patient Safety (SPS).

Design/Methods
A neonatologist / respiratory therapist pair was assembled in March 2022 to tackle rising UE rates in a 69 bed NICU. Contributing unit stressors included implementation of a new electronic health record, COVID-19 policies, and nursing shortages. Baseline UE rates were &gt;3x the centerline for SPS network NICUs and likely underreported. Steps undertaken include: 1) daily audit to ensure reporting of all UEs, 2) structured post-event team debriefs, 3) unit education campaign to raise awareness of UE prevention and bundle elements, 4) prominent posting of last UE date and reporting on daily team huddle, 5) rapid UE case reviews and apparent cause analysis with reporting of findings unit-wide, 6) optimize endotracheal tube (ETT) securement methods, 6) enforce T2-T3 ETT tip position, 7) standardize x-ray frequencies and reporting, 8) trial of daily rounds ETT safety checklist.

Results
From rapid case reviews, apparent causes were determined to be incorrect ETT securement device sizing, taping method prone to loss of tape integrity in high humidity, high ETT positions, and inadequate ETT monitoring during high risk activities other than repositioning (invasive/painful procedures, diaper changes). Post-event structured debriefs and unit-wide vigilance increased reporting of UE events to 100%. UE rates fell from a peak of &gt;4 UEs/month, &gt;2.4/100 ventilation days to 1 UE/month, 0.465/100 ventilation days, a 80% reduction.(Figure 1) Most impactful interventions were standard x-ray reporting template in the electronic health record, reinforcing T2-T3 ETT tip positioning, correcting ETT holder sizing, and change in ETT method (Figure 2). Daily rounds checklist was not effective. UE reductions were achieved without changing patient ratios as nurse staffing shortages continued.

Conclusion
A nimble systems approach is needed to ensure success in implementation of UE prevention care bundles. Simple changes can be made to decrease UEs, guided by rapid case reviews.
Paricalcitol ameliorates diabetic nephropathy by promoting EETs and M2 macrophage polarization and inhibiting inflammation by regulating VDR/CYP2J2 axis
Authors: Tang Shiqi , Tan Jun , Yang Shikun , Li Aimei , Liu Jishi , Zhang Wei , Zhang Hao , Liu Yan 
Published: October 2024

AbstractPrevious studies have shown that paricalcitol (PA) has a protective effect on the kidneys. However, the exact molecular mechanism by which PA affects diabetic nephropathy (DN) progression remains uncertain. PBMCs of patients with DN were isolated, and CYP2J2 and VDR levels were detected by qPCR. Pearson correlation analysis was utilized to detect the relationship between uACR and CYP2J2 and VDR and between CYP2J2 and VDR. The protective effects of PA on DN have been examined by TUNEL, HE staining, ELISA, and Flow cytometry assays in STZ‐induced mice. Moreover, THP‐1 cells were stimulated with HG/LPS for in vitro studies. ELISA, qPCR, western blot, and Flow cytometry assays were utilized to assess the effects of PA on DN progression by regulating CYP2J2. The interaction between CYP2J2 and VDR was analyzed by CHIP‐qPCR and luciferase experiments. CYP2J2 and VDR levels were downregulated and uACR level was upregulated in DN patients. CYP2J2 and VDR were positively correlated in PBMCs. Both CYP2J2 and VDR are inversely correlated with uACR. Moreover, after PA treatment, 11, 12‐EET levels increased, inflammatory factor levels decreased, and M2 macrophage polarization was promoted in STZ‐induced mice and HG/LPS‐triggered THP‐1 cells. Depletion of CYP2J2 and VDR decreased 11, 12‐EET level, enhanced inflammatory factor levels, and inhibited M2 macrophage polarization, which were reversed by CYP2J2 overexpression in HG/LPS‐treated cells. Furthermore, VDR bound to the CYP2J2 promoter and promoted CYP2J2 transcriptional expression. The present work pointed out a new use for PA to inhibit DN progression by increasing EET level, inhibiting inflammatory response, and inducing M2 macrophage polarization via regulating the VDR/CYP2J2 axis.