bluuebunny/crossref_metadata_2025_split huggingface dataset:
80 Family Caregiver Emotional and Communication Needs in Canadian Paediatric Emergency Departments
Authors: Maki Claudia , Rahimi Asa , Ma Keon , Yaskina Maryna , Wong Helen , Stang Antonia , Principi Tania , Poonai Naveen , Gouin Serge , Froese Sylvia , Clerc Paul , Carciumaru Redjana , Alqurashi Waleed , Rajagopal Manasi , Kammerer Elise , Leung Julie , Wright Bruce , Scott Shannon , Ali Samina 
Published: September 2023

Abstract

Background
Paediatric emergency departments (EDs) have been identified as inherently stressful for families, making it challenging to understand and meet families’ global needs, beyond urgent medical care. There is a paucity of research describing how effectively the emotional and communication needs of family caregivers are met during ED visits.

Objectives
To describe the extent to which family caregivers’ emotional and communication needs were met during paediatric ED visits and relate these findings to visit and demographic characteristics.

Design/Methods
Electronic surveys with medical record review were deployed at ten Canadian paediatric EDs from October 2018 – March 2020. A convenience sample of families with children &lt;18 years presenting to a paediatric ED were enrolled, for one week every three months, for one year per site. Caregivers completed one survey in the ED and a follow-up survey, up to seven days post-visit.

Results
This study recruited 2005 caregivers who were mostly identified as mothers (74.3%, 1462/1969); mean age was 37.8 years (SD 7.7). 71.7% (1081/1507) of caregivers felt their emotional needs were met. Staff physicians (35.6% [535/1502]), bedside nurses (24.2% [364/1502]), residents/medical students (13.8% [207/1502]) and triage nurses (12.4% [186/1502]) were identified as providing the best emotional support to caregivers. 86.4% (1293/1496) identified communication with the doctor as good/very good and 83.4% (1249/1498) with their child’s nurse. Caregiver involvement in their child’s care was reported as good/very good 85.6% (1271/1485) of the time. 81.8% (1074/1313) of caregivers felt comfortable in caring for their child at home at the time of discharge. Greater triage acuity, being the father (vs. mother), lower caregiver anxiety, respect for the child’s privacy, caregiver involvement in their child’s care, satisfactory updates, and having questions adequately addressed positively impacted caregiver emotional needs. Caregivers feeling less scared during an ED visit, lower caregiver anxiety, caregiver involvement in their child’s care, satisfactory updates, and having questions adequately addressed increased caregiver comfort in caring for their child’s illness at home.

Conclusion
Approximately 30% of caregivers presenting to paediatric EDs have unmet emotional needs, over 15% have unmet communication needs, and 15% felt inadequately involved in their child’s care, challenging healthcare providers to do better. Family caregiver involvement in care and good communication from ED staff are key elements in improving overall patient experience and satisfaction.
85 Incidence of Intravenous Immunoglobulins-related Adverse Events in Children
Authors: Chaloult-Lavoie Mathilde , Pelland-Marcotte Marie-Claude , Poulin Elisabeth , Hayes Laurence Amélie , Ouellet Pierre , Côté Jade 
Published: September 2023

Abstract

Background
Intravenous immunoglobulins (IVIG) therapy is increasingly used in the treatment of various paediatric diseases. Data about frequency and underlying mechanisms of IVIG-related adverse events (IVIG-AEs) in children are limited.

Objectives
Objectives of this study were to document the incidence of IVIG-AEs in paediatric hospitalized patients and identify risk factors for IVIG-AEs.

Design/Methods
In this retrospective cohort study, we included patients aged &lt; 18 years old who received IVIG therapy, for any indication, as inpatients at a Canadian paediatric tertiary care centre between 2016-2020. Patients and IVIG-perfusion characteristics were collected, as well as any AEs occurring during the perfusion or up to 10 days after. AEs were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Bivariate and multivariate logistic regressions were used to explore the associations between patients’ characteristics and the incidence of IVIG-AEs.

Results
We included 228 children in this study (mean age: 4 years), receiving 478 IVIG infusions. Indications for IVIG infusions included inflammatory (120/228, 52.6%), replacement (27/228, 11.8%) and auto-immune (81/228, 35.5%) disorders. A total of 211 IVIG-AEs were reported in 89/228 (39%) of patients, and 125/478 (26.2%) of infusions. Fever (65/478, 13.6%) was the most frequent AE, followed by headache (32/478, 6.7%) and tachycardia (31/478, 6.5%). Most IVIG-AEs were of mild (121/211, 57%) or moderate (66/211, 31%) severity, but 12% (24/211) were severe reactions (serious AEs or grade 3-4), and no fatal reactions (grade 5) were encountered. The highest proportion of IVIG-AEs occurred when administered for inflammatory conditions. Older age, dehydration, first infusion, higher IVIG dosage and concurrent allergies were significantly associated with IVIG-AEs, while treatment with a steroid was significantly associated with a reduced risk of AEs.

Conclusion
IVIG-AEs are frequent in children. While most of them are self-limited, more serious complications may occur. Adequate hydration, low concentrations of IVIG products and the administration of glucocorticoid prior to the infusion could minimize these AEs. Further research is necessary to prevent IVIG-AEs in high-risk children.
87 Infant Malrotation with Midgut Volvulus Presenting in the Paediatric Emergency Department or the Neonatal Intensive Care Unit: A Retrospective Review for a Quality Improvement Initiative
Authors: Trottier Evelyne D , Filion Ludovik , Blondin Sarah Emmanuelle , Beaunoyer Mona , Miron Marie Claude , Assaad Michael 
Published: September 2023

Abstract

Background
In neonates, bilious vomiting is considered malrotation with midgut volvulus (MV) until proven otherwise, given its associated high morbidity and mortality. The diagnosis is time-critical, requiring prompt identification to avoid complications. Many of these patients are described as clinically well at time of presentation, possibly delaying definitive management.

Objectives
This study was a retrospective quality initiative aimed to evaluate the clinical presentation of infants and children with MV in a single paediatric tertiary care centre emergency department (ED) and neonatal intensive care unit (NICU). The study also aimed to identify delays in the management pathway.

Design/Methods
Patients with a final diagnosis of MV presenting to the ED/NICU were identified between January 2015 and May 2022. Patient demographics, signs and symptoms at presentation, initial laboratory studies, imaging, and surgical findings were recorded. The following time points were recorded: (1) first medical evaluation, (2) radiologic investigations (abdominal X-ray [AXR], ultrasound [US], upper gastrointestinal radiography [UGI]), (3) consultation with surgical team, and (4) time to surgery.

Results
During the study period, 29 paediatric patients presented a diagnosis of MV (ED: 21, NICU: 8). The median age at presentation was 7 days (3-13.5), with 27/29 (93%) being less than 3 months. From them, 21 patients (72%) were male. Bilious green (17/26) and/or yellow (13/26) vomiting was the most frequent presentation in 26/26 (100%), the three other patients had missing data. Five patients (17%) had a pH &lt; 7.30 (with base deficit &lt; -5) and seven (24%) patients had a glucose value &gt; 7 mmol/L. Abdominal radiograph was performed in 17/29 (59%) patients. All (100%) had ultrasound (US) which was diagnostic in 24/29 (83%) cases. Six upper gastrointestinal series (UGI) were performed, being diagnostic in all cases (100%). The Ladd’s procedure was the standard treatment for every patient (100%). Median time between arrival and US was 151 minutes (71 – 243), UGI was 347 min (246 – 800) and surgery was 299 minutes (204-371). In the NICU specifically, six cases were referrals, with the median time between the first documented bilious vomit and the call from the referral centre being 660 minutes (335-1104). Of the 29 cases, 27 (93%) survived and from them, one suffered a short bowel complication.

Conclusion
Bilious (green/yellow) vomiting is a reliable clinical sign of MV in infants, being always aware that yellow may be bile. Ultrasound is a rapid test with more than 80% diagnostic accuracy. Delay for definitive surgery was considered slightly high. This quality initiative will help develop a clinical practice guideline and algorithm to reduce delays for infants presenting with MV.
92 Trends in COVID-19 Vaccination Coverage among Children &lt;5 Years of Age in Canada
Authors: Jeevakanthan Ahash , Mi Fane Brigitte Ho , Roubos Sophia 
Published: September 2023

Abstract

Introduction/Background
COVID-19 vaccinations for those aged 6 months to 5 years were announced in the summer of 2022. Specifically, Moderna Spikevax and Pfizer-BioNTech Comirnaty were authorized on July 14, 2022, and September 9, 2022, respectively. Given that this was the last age group to become eligible for vaccination against COVID-19, promoting and measuring vaccination coverage in this vulnerable population is of public health significance.

Objectives
This analysis describes and compares the trend in vaccination coverage (VC) over the initial weeks of eligibility in those 0-17 years old.

Design/Methods
Data were obtained from the Canadian COVID-19 Vaccination Coverage Surveillance System and were analyzed to describe and compare VC of those &lt;5, 5-11, and 12-17-year-olds over the first 16 weeks of eligibility. VC is defined as the percent of the population that have received at least 1 dose of a COVID-19 vaccine.

Results
Sixteen weeks after those &lt;5 years became eligible for vaccination, coverage was 10.9% in those aged 2-4 and 6.3% in those aged &lt;2. Compared to other paediatric age groups, VC in those &lt;5 is markedly lower, where, after 16 weeks of eligibility, coverage in those aged 5–11 was 54.4% and 81.5% in those 12-17. There was an immediate spike in coverage for both 5–11-year-olds and 12–17-year-olds over the first 4 weeks following eligibility, where VC was 40.1% and 63.3%, respectively. A similar increase was not observed 4 weeks following eligibility in those aged &lt;5, where VC was 7.4% in those aged 2-4 and 4.0% in those &lt;2. The weekly increase in VC decreased more rapidly as age groups decreased; weekly increase in VC slowed to less than 1% in 28 weeks, 20 weeks, and 16 weeks after eligibility in those aged 12-17, 5-11, and &lt;5, respectively.

Conclusion
These data suggest that VC over time in the &lt;5 population has been slow and has not followed the trajectory of other paediatric populations, when compared to the 5-11 and 12-17 age groups. Reasons for this may include but are not limited to parents and guardians’ knowledge, attitudes, and beliefs toward getting their infant children vaccinated, as well as pandemic fatigue, as eligibility for the infant population occurred after the other paediatric age groups.
95 Teaching Them to Fish: Developing and Implementing a MicroResearch Training Program for Elementary School Students
Authors: Filliter Jillian , Hunter Kelly , Newell Caitlin , Kielley Karen , MacDonald Noni , Taylor Michael , Oyesiji Oyedolapo Oyetola , Towns Zachary , Pinsent Penny , Ricciardelli Rosemary 
Published: September 2023

Abstract

Introduction/Background
The MicroResearch (MR) program was developed to build local research capacity by providing community-focused research training and mentorship to health professionals. MR supports trainees, who are community members themselves, in identifying health problems relevant to their communities and developing solutions tailored to local context, culture, and resources. The MR team has received numerous inquiries about adapting the program for delivery in schools to foster key critical thinking and reasoning skills through hands-on participation in research.

Objectives
The goals of the current project were to: 1) adapt the MR curriculum to the learning needs of Grade Six students while retaining the program’s core content, 2) implement MicroResearch in Schools (MRiS) for the first time in a classroom setting, and 3) examine the feasibility of MRiS from student and facilitator perspectives.

Design/Methods
Twenty-one Grade Six students, divided into four research teams, participated in the first MRiS offering. One graduate student coach was assigned to each team and a local researcher with MR experience was a coach mentor. The traditional 10-day workshop model was replaced with 13 sessions across three months. Content was delivered through presentations on research topics and teamwork with coaches and reinforced by the classroom teacher between sessions. Key curriculum adaptations included shorter lectures; simplified language and concepts; structured worksheets; engaging examples, games, and activities; and a field trip to tour a research institution and library. Each team identified a research question and, guided by their coach, developed a research proposal that they presented to a panel of judges. Feasibility was evaluated based on achievement of MR goals, questionnaires completed by students, and verbal and written feedback from facilitators (teacher, coaches, presenters).

Results
All four teams developed health-related research questions and proposals that were deemed relevant, feasible, important, and innovative by a panel of judges. Student and facilitator feedback indicated that MRiS has good potential as an effective and engaging way to teach research concepts and skills to senior elementary school students. Several opportunities to further tailor the program to the classroom setting were identified (e.g., ways to make the content even more engaging and ensure sufficient role clarity and support for coaches).

Conclusion
Overall, our results suggest that MRiS is feasible and, with some further adaptations, could be a vital mechanism for fostering critical thinking and reasoning skills in students. We will follow the same students as they carry out their research projects and expect that this will further reinforce these invaluable skills.
99 Feasibility of a Co-designed Community Intervention for Families of Children with Developmental Diagnoses
Authors: Parmar Puneet , Suleman Shazeen , Kelly-Adams Deidre , Nwebube Chioma 
Published: September 2023

Abstract

Background
The COVID-19 pandemic has created considerable difficulties and barriers to accessing care for families of children with developmental disability (FCDD), particularly for families who are socially or economically marginalized. We have previously found that families have reported increased caregiver stress, difficulty navigating services and worsened social isolation. Building on these findings, a community-based intervention was co-created with community partners and families to improve social support, caregiver empowerment and access to services (see Figure 1, below), consisting of a ‘toolkit’ of resources with an accompanying workshop for caregivers and community service providers (CSPs), and a chat group community of support for caregivers.

Objectives
This study explored the feasibility of the co-designed intervention, examining the acceptability, implementation, and demand.

Design/Methods
This was a mixed-methods feasibility study, which incorporated quantitative and qualitative evaluation components, and received Research Ethics Board approval (SMH 20-127). Demand and implementation were assessed by measuring participant attendance in the workshops. Acceptability was assessed using post-workshop questionnaires to measure satisfaction and knowledge uptake, and further explored in semi-structured interviews, which were recorded, transcribed and analyzed using thematic analysis. Any caregiver, and CSPs who participated in any arm of the intervention, were invited to participate.

Results
Workshops were held 6 times (4 caregiver workshops, 2 staff workshops) in two community partner sites. A total of 55 participants (32 caregivers, 23 staff) participated. After receiving the toolkit and attending the workshop, both caregivers and CSPs reported that they felt more comfortable with navigating services, which was higher in CSPs (4.58/5, p&lt;0.005). 100% of participants wanted additional iterations of the workshops with the toolkit. In the IDIs, both CSPs and caregivers reported that the toolkit was comprehensive and easy-to-use. Many caregivers reported using the toolkit immediately after the workshops to connect to new services. Among both CSPs and caregivers, it was found that the group chat was not commonly used but had the potential to be a helpful tool to share additional resources and discuss specific topics.

Conclusion
This community-based, co-created intervention was implemented successfully, with high acceptability and demand. Both CSPs and caregivers found the toolkit to be useful and have used it to successfully access services, while the group chat was less used. Our study demonstrates the critical importance of working alongside community to co-create interventions to best serve specific community needs.
C9 (Clinical Case) Monkeypox Virus Infection in a 2-Month-Old Infant
Authors: Payette Justine , Saleh Sima , Renaud Christian , Coulombe Jérôme , Quach Caroline , Charest Hugues 
Published: September 2023

Abstract

Introduction/Background
The 2022 Monkeypox virus outbreak shed attention on an illness that is rare in non-endemic countries. Children are at risk of severe disease based on case series from previous outbreaks. Tecovirimat may be considered as a therapy in young children. Its efficacy and safety profile, however, have never been formally studied. This case report presents the first laboratory-confirmed case of monkeypox virus infection in a Canadian infant and its management.

Case Description
A 2-month-old infant presented to an emergency department with a vesiculopustular skin rash. A week before, parents noticed an eruptive cluster of 3 fluid-filled vesicles on the infant’s forehead. In the next days, vesiculopustular lesions appeared on his body. One spike of temperature was reported with no other sign of illness. On physical examination, a dozen umbilicated well-circumscribed vesico-pustules were observed with minimal skin inflammation. They ranged from 2 to 5 mm in size and were scattered over the face, trunk and limbs including palms and soles. In addition, 3 confluent crusted umbilicated lesions were present on the forehead.

Discussion
Differential diagnosis included varicella zoster virus, herpes simplex virus, and enteroviral infections. Empiric intravenous acyclovir was initiated pending specimen analysis. Bacterial culture and viral PCRs were negative on CSF and skin specimens. Due to transmission of monkeypox in the local adult population, orthopoxvirus was tested by PCR. The result was positive on a skin specimen and was later confirmed by the National Microbiology Laboratory of Canada.
Because of the patient’s age and ongoing new lesions, tecovirimat was initiated. After 24 hours, new lesions stopped appearing and regression and crusting of active lesions were noted. Treatment was continued for 14 days without adverse events.
Although parents denied similar symptoms, an epidemiological link was postulated, given work exposure in a setting with high risk of transmission in one of them.
This case adds insight on the clinical features, the course of disease and management in infants. This 2-month-old infant did not develop any complication from the illness and was among the youngest patients with monkeypox to be treated with tecovirimat.

Conclusion
As monkeypox infection remains rare in children and may convey a higher risk for severe disease, a high degree of suspicion is warranted for clinicians caring for children. Monkeypox should be included in the differential diagnosis of an unexplained vesiculopustular rash. Finally, tecovirimat as a treatment for monkeypox infection in children was shown here to be safe and effective, even when started late in the evolution.
Integrative revision of the Lygodactylus gutturalis (Bocage, 1873) complex unveils extensive cryptic diversity and traces its evolutionary history
Authors: Lobón-Rovira Javier , Bauer Aaron M , Vaz Pinto Pedro , Trape Jean-Francois , Conradie Werner , Kusamba Chifundera , Júlio Timóteo , Cael Garin , Stanley Edward L , Hughes Daniel F , Behangana Mathias , Masudi Franck M , Pauwels Olivier S G , Greenbaum Eli 
Published: September 2023

Abstract
Lygodactylus is the most speciose gekkonid group in Africa, with several additional, candidate species already identified from previous studies. However, in mainland Africa, several groups remain only partially resolved, and there are several taxonomic inconsistencies. Lygodactylus gutturalis was described from Guinea-Bissau in the 1870s and since then, the species has been recorded from West to East Africa, and it is widely distributed through different biomes and ecoregions. However, this taxon has never been studied in detail. In this work, we use an integrative approach, including molecular phylogenetic analysis, morphometrics, skull osteology, and biogeography to provide the first systematic revision of the L. gutturalis species complex. The L. gutturalis complex is a subgroup within the L. picturatus group and includes nine well-differentiated species. We elevate Lygodactylus gutturalis dysmicus to full species status, recognize Lygodactylus depressus as the sister species to L. gutturalis, describe five new species (Lygodactylus kibera sp. nov., Lygodactylus karamoja sp. nov., Lygodactylus mirabundus sp. nov., Lygodactylus leopardinus sp. nov., and Lygodactylus gamblei sp. nov.), and propose an additional candidate species that requires further research. Also, in order to shed light on some taxonomic inconsistencies between the L. gutturalis and Lygodactylus angularis groups, we revisit the L. angularis group, within which we elevate Lygodactylus angularis heeneni and Lygodactylus angularis paurospilus to full species status. The L. gutturalis subgroup diversified during the Late Miocene (between 5–15 Mya), probably as a consequence of multiple vicariant events driven by the expansion of the African savannahs and the establishment of climatic refugia.
Prolidase Deficiency Causing Recalcitrant Leg Ulcerations in Siblings
Authors: Hajjar Nancy , Kabbani Mariam , Tannous Rim , Lebre Anne-Sophie , Megarbane Andre , Minari Afaf , El Sayed Fouad 
Published: September 2023

ABSTRACT
Prolidase deficiency (PD) is a rare autosomal recessive genodermatosis with variable clinical manifestations. It results from a mutation in the peptidase-D gene that leads to abnormal activity of the prolidase enzyme, an important player in collagen catabolism. The authors report the case of two siblings presenting with dysmorphic features, disturbed blood panel, and recalcitrant leg ulcerations of several years’ duration. Sequencing of the 15 exons and of the intron/exon junction regions of the peptidase-D gene revealed the presence of a homozygous pathogenic variant c.549-1G > A. An ointment with 5% proline and 5% glycine was compounded, and the patients were instructed to apply it once daily. A follow-up visit after 8 months revealed partial improvement of the ulcerations starting from the third month of treatment. These authors hope this case report sheds light on this disease and recommend it be incorporated into the differential diagnoses of chronic leg ulcerations, particularly those starting at a young age.