bluuebunny/crossref_metadata_2025_split huggingface dataset:
6 Evaluation of a Standardized Kawasaki Disease Protocol for Management and Follow-Up
Authors: Iseman Rachael , Lai Lillian , Zucker Marc , Roth Johannes , Jackson Elayna 
Published: September 2023

Abstract

Background
In 2017, it was recognized that there was significant variation in the management and follow-up of Kawasaki disease (KD) at our institution, resulting in inefficient use of hospital resources and patient confusion. A multidisciplinary team from cardiology, rheumatology, emergency medicine, infectious diseases (ID), and general paediatrics created a standardized protocol distributed on October 10th, 2019. With the evolution of multisystem inflammatory syndrome in children associated with SARS-COVID 19 (MISC), we expanded our protocol in December 2021 to include a 1-week follow-up echocardiogram (echo).

Objectives
It has been 3 years since the KD standardized protocol was implemented. As a result, we seek to evaluate its effectiveness in improving patient care, specifically in the patients with normal coronary arteries.

Design/Methods
We reviewed the cardiology echo database to define patients who had an echo performed for KD (January 1, 2020-August 17, 2022). These patients were reviewed in the electronic hospital record to define those with a discharge diagnosis of KD.

Results
Of the 138 patients defined, 47 patients were discharged with KD; normal coronary arteries (N=38) were seen in 81% (38/47). Classic KD: 47% (18/38); incomplete KD: 53% (20/38); 13% (5/38) were diagnosed with both MISC and KD. Average age: 3.4 years (3 months to 9.5 years). We observed that rheumatology was consulted in 89% (34/38), cardiology in 100%, and ID in 50% (19/38). All patients were treated with low-dose acetylsalicylic acid (38/38), and the majority were treated with intravenous immunoglobulin, 92% (35/38). Some patients were treated with steroids, 26% (10/38). Average length of stay: 4.8 days (1-18 days).
Twenty-one patients were seen from when we initiated performing a 1-week echo. In addition to the existing protocol, 24% (5/21) of cases missed having a 1-week follow-up echo because the cardiologist was not aware of the practice. Eighty-nine% (34/38) had their 6-week follow-up echo and follow-up in the post-hospitalization clinic (PHC) at the appropriate time. Patients were incorrectly scheduled to see the cardiologist in 13% (5/38) and the PHC in 3% (1/38) cases.

Conclusion
With the implementation of a standardized management and follow-up protocol for KD, our patients are now guaranteed follow-up with access to effective patient-centred care in a streamlined manner that targets appropriate use of resources. A satisfaction survey should be performed to inquire if families are pleased with this process.
7 Ethical Dilemmas Faced by Healthcare Professionals when Considering a Report to Child Protection: Experiences and Perspectives from a Tertiary Paediatric Centre
Authors: Low-Decarie Clara 
Published: September 2023

Abstract

Background
Child maltreatment is an important global problem that is increasingly being recognized as a public health issue as well as a violation of children’s fundamental rights. Mandatory reporting is a legislative attempt to decrease its prevalence and impacts. It is generally thought that these laws improve child maltreatment detection rates. However, the actual effects of such laws, as well as mandated reporters’ perspectives on them, remain unclear. Several studies have explored the many obstacles perceived in the reporting process, including some of which can be considered as moral dilemmas. Very few of these studies have explicitly adopted an ethical lens in the analysis of these situations.

Objectives
Through an exploratory study, our aim was to describe the experiences and perspectives of healthcare professionals from a large paediatric university centre when considering making a report to child protective services. We were interested in the reporting process rather than initial identification. We also explored how profession (nurse, doctor or resident), work environment (general paediatrics team, NICU or ED) and years in practice influenced participants' answers. Additional questions addressed the concept of disclosure of reports to families involved, training on child maltreatment and reporting, and perceived impacts of the COVID-19 pandemic on children’s safety.

Design/Methods
One hundred and thirty-five respondents answered an anonymous online survey constructed by the research team and based on a review of the available literature.

Results
Most participants (96%) had encountered situations of possible child maltreatment through their work and reported being committed to their mandated reporting obligations. However, only 44% of respondents had personally reported a situation to protective services. Teamwork and/or delegation of reporting duties seemed to contribute to the gap between exposure and reporting experiences. Sixty nine percent of participants felt that families should be told about healthcare professionals’ concerns at least as often as possible, but many expressed significant concerns, mostly related to their own safety and well-being. Training was lacking according to 88-89% of respondents. Regarding the COVID-19 pandemic and associated restrictions, participants were concerned for children’s safety in their homes.

Conclusion
Many ethical aspects of the reporting process should be considered when addressing a particular situation but also when teaching and training professionals in the identification and reporting of child maltreatment.
8 Characterizing Opioid Overdose Deaths in Children (COODC Study)
Authors: Assen Katrina , Rieder Michael , Wilson Michael , Urbantke Elizabeth 
Published: September 2023

Abstract

Background
With the opioid epidemic the numbers of fentanyl-related adult deaths are increasing in Canada but there is limited knowledge of fentanyl’s effect on paediatric deaths.

Objectives
Our aim is to describe cases of fatal paediatric opioid toxicity, and their characteristics, to help guide public policy and health care system response.

Design/Methods
Patient information was collected from the opioid investigative aid (OIA) database, which collects all suspected opiate-related deaths in Ontario. A chart review was performed on patients less than 10 years of age between October 1st, 2017, to October 31st, 2021. Patient characteristics were calculated as percentages and a descriptive analysis was conducted.

Results
10 childhood deaths occurred, and the average age was 1.9 (Table 1). The causative opioid was fentanyl alone in 40% of cases, fentanyl in combination in 40%, and hydromorphone and methadone with 10% each. Most cases involved improperly stored medication or illicit substances (Table )2. All had previous child protection service involvement.

Conclusion
In patients less than 10 years of age, there were ten opioid-related deaths over four years, all in children younger than 5 years. Fentanyl was the primary drug involved in 80% of cases. This demonstrates the rise of fentanyl-related opioid deaths in children and elucidates areas for change, including education, proper storage of illicit substances, and implications for the child protection system.
13 “Don’t Want to Be in the Room? Never. Can’t Be in the Room? Yes”: A Mixed Methods Analysis of Barriers and Facilitators to Parental Presence at the Bedside in a Paediatric Intensive Care Unit
Authors: Poole Emily , Ryan Molly , Curran Janet , Foster Jennifer 
Published: September 2023

Abstract

Background
Though a paediatric intensive care unit (PICU) admission is overwhelming for families, bedside parental presence improves child comfort, reduces parental anxiety, and enables family engagement. Previous research has focused on parental presence during events (rounds, resuscitation, and procedures), but little is known about factors influencing parental presence at their child’s bedside for routine PICU care.

Objectives
To identify factors that parents perceive as impacting their capability, opportunity, and motivation to be at the bedside in PICU, and explore parental perceptions about the quality and value of time spent at the bedside.

Design/Methods
This mixed methods study used semi-structured interviews based on the Theoretical Domains Framework (TDF). Participants were parents of children admitted to a Canadian PICU. Participants completed a demographics form and the Medical Term Recognition Test (METER) to assess health literacy. Interviews were coded independently by two researchers using a directed content approach based on the TDF. Once consensus was reached, themes and subthemes were identified inductively within each domain to generate barriers and enablers. Factors were examined for trends based on dichotomized demographics.

Results
Fourteen primary caregivers participated in 11 interviews. Participants were 8 mothers and 6 fathers, of children with both planned (n=4) and unplanned (n=7) admissions. METER scores ranged from 4 to 40, with a mean of 31. Seventy-six barriers and enablers were identified within 13 domains. Factors were most commonly in the ‘environmental context and resources’ domain (n=13) and included “comfortable and functional physical environment”, “medicalization of the child”, and “PICU technology”. Parents emphasized the importance of self-care which, although requiring parents to leave the bedside, allowed them to be fully engaged when they were present. A ubiquitous factor was “maintenance of the parent role”. Parents felt responsible to be present, but recognized alterations in the parental role while in PICU. Parents who were &lt;25 years old, fathers, or those who had first and unplanned PICU admissions identified relatively fewer skills and capabilities supporting their presence. Multiple factors, particularly in the domains of social influence and environmental context, are potentially modifiable to better support parental presence and engagement at the bedside.

Conclusion
Parents perceive multiple factors influencing their capability, opportunity, and drive to be present with their critically ill child in PICU, some of which are amenable to direct intervention by healthcare professionals and hospital policy. Healthcare professionals may maximize parental engagement by attempting to optimize quality, rather than quantity, of time at the bedside.
21 Cross-sectoral Care for Transitional Aged Youth (TAY) with Autism Spectrum Disorders and Intellectual Disabilities (ASD/IDD)
Authors: Young Elizabeth , Henze Megan , Nallathamby Shanthiya , Jegathesan Thivia , Green Laurie , Weyman Karen , Isaacs Barry , Loh Alvin , Milligan Karen 
Published: September 2023

Abstract

Background
The Transition Clinic for Youth and Young Adults (TAY clinic) with ASD/IDD is a unique partnership between the Developmental Sector and Health care sector. Surrey Place Centre, St. Michaels Family Health Teams and Developmental Paediatrics work with families of adolescents and young adults ages 14-22 to help transition from paediatrics-based healthcare and developmental services to adult sectors using a structured approach to transition. This clinic was a pilot project over the past 5 years, and we are using a mix-methods study to evaluate the implementation of the clinic and its impact on the lives of TAY with IDD and their caregivers.

Objectives
To describe patient and caregiver characteristics, usage of clinic, transition goals stated and achieved, and level of support needed.

Design/Methods
Quantitative data was collected using standardized forms including demographics, transition planning goals, and dates of applications to critical services like Developmental Service Ontario and Ontario Disability Support Program. The frequency, intensity and duration of transition planning support provided in the clinic was documented, as well as involvement of crisis services, child protection services, networks of specialized care, and hospital admissions.

Results
To date, 94 families have been supported through this clinic, with notable differences in the intensity and type of services required. Families were evenly distributed across three levels of transitional support need: (1) required consultation only; (2) required short-term intervention and follow up from the team with future crisis planning; and (3) families with extreme complexity, disconnected from the developmental sector and requiring intensive support and, at times, crisis care. In this 3rd group, 30% were regular emergency and crisis service users because of significant risk of harm or death to client or caregiver associated with physical or mental health concerns, and 15% were at risk of homelessness. Barriers to social determinants of health (e.g., housing, food security, social support) and inequities (based on race, immigration status, employment, English language proficiency) were present in all cases. Across all 3 groups, trajectories within the current systems of care were often apparent years before their transition.

Conclusion
Cross-sector models of care are feasible for TAY with IDD. This model of care identified different levels of need for TAY with IDD. Barriers to transition support are rooted in inequities and are often present years prior to transition. Paediatricians can help with earlier identification of families who require and deserve more comprehensive support.
25 Severe and Life-threatening Opioid, Stimulant, and Sedative Use in Canadian Youth: A One-time Survey of Paediatricians and Paediatric Subspecialists
Authors: Carwana Matthew , Chadi Nicholas , Moore Eva , Shariati Helia , Citron Sara 
Published: September 2023

Abstract

Background
Toxic drug supply is a public health emergency in Canada. The syndemic impact of Covid-19 has exacerbated the adverse outcomes of overdose, driving up mortality rates. Despite the fact that opioid use disorder is predominantly viewed as an adult issue, an increasing number of youth in Canada experience severe-life threatening overdose; it is the leading cause of death in youth ages 10-18 in Western Canada. Epidemiologic data related to this population remains limited.
1.Objectives: To determine the minimum incidence of children and adolescents presenting with severe or life-threatening opioid, stimulant, and sedative exposure among youth presenting to Canadian paediatricians and paediatric subspecialists.
2.To describe the treatment and services available for youth presenting with substance use to paediatric care in Canada.

Design/Methods
A one-time cross-sectional survey of Canadian paediatricians and paediatric subspecialists using the Canadian Paediatric Surveillance System (CPSP) was conducted in the Spring of 2022. A population denominator of 2,900,866 was selected based on Statistics Canada census data for children and youth 12-18 in 2021. Data were analyzed using Stata v15.1.

Results
1027 respondents (response rate: 37%) completed the survey, of whom 934 (90.9%) reported providing care to children and youth 12 years and above. 115 (12.3%) respondents indicated managing a youth with severe or life-threatening substance use in the prior 24 months. Most providers operated in urban settings (n=95, 84.8%), but there were cases reported in suburban (n=9, 8.0%) and rural/remote (n=8, 7.1%) environments as well. Calculated minimum cumulative incidence per 100,000/year were: opioid overdose 2.94; opioid use requiring pharmacotherapy 1.69; stimulant toxicity 3.22; and sedative toxicity 3.1 (Table 1). Respondents also reported service availability for youth substance use. Respondent awareness of the availability of overdose-related services was high for outpatient mental health services (85.4% for 12 to15-year-olds, 86.1% for 16 to18-year-olds), but poor to moderate (25.3%-53.1%) for all other surveyed services, including inpatient stabilization and intensive outpatient management.

Conclusion
Paediatricians and paediatric subspecialists interface significantly with youth experiencing severe substance use and overdose. The minimum calculated incidence rates provided are significant and concerning at the population level, despite excluding youth that do not seek physician care after overdose. Paediatric providers have limited awareness of service availability for youth that use substances. Further studies and knowledge translation are required.
26 How Are We Addressing Health Equity in the Paediatric Tertiary Care Setting? An Environmental Scan of Approaches across Canada
Authors: Naguib Mariam , Li Patricia , St-Georges Juliette , Korman Catherine , Chabot Annie , Benkelfat Rislaine 
Published: September 2023

Abstract

Background
Increasingly, paediatricians are asserting the urgent need for effective practices and policies to address child health inequities. Yet there is a paucity of data on the current approaches implemented in Canadian paediatric tertiary care centres. According to the Institute of Health Improvement (IHI), health equity is paramount for a just society that moves toward better well-being for all. The IHI framework lists five priorities to guide health equity initiatives: make health equity a strategic priority; develop structures and processes to support health equity work; deploy specific strategies to address the multiple determinants of health on which health care organizations can have a direct impact; decrease institutional racism within the organization; and develop partnerships with community organizations.

Objectives
The objectives of this study were to: 1) Map out current initiatives addressing health equity, and 2) Explore the facilitators and barriers to achieving health equity, in the tertiary paediatric health care setting in Canada.

Design/Methods
We conducted an environmental scan using in-depth, semi-structured interviews as well as a review of the grey and published literature. We interviewed at least one paediatric resident and one staff (including paediatricians, allied health professionals, and administrators involved in health equity) at all 17 paediatric tertiary care centres in Canada. The interview guide was structured using the IHI framework, to characterize initiatives, as well as facilitators and barriers, to address health equity. We performed a thematic analysis using NVivo. Codes were generated using an inductive and deductive approach, from which themes were identified, refined, and finalized.

Results
We conducted 41 interviews from Fall 2021 to Fall 2022. Recent events, including Black Lives Matter and the COVID pandemic, fuelled health equity initiatives at the hospital- and university-levels. Most institutions were in a reactionary state, with few having formal strategic approaches to address inequities. The initiatives served a variety of priority populations: Indigenous, Black, migrants, rural communities, and children with disabilities, with the focus differing based on geography and the unique challenges faced by each institution. To achieve equity throughout an organization, equity at the staffing level was identified as being a necessity. The barriers to implementing health equity initiatives included lack of accountability, lack of leadership support, limited resources, and lack of institutional awareness. The facilitators included leadership support, health equity champions, and increasing awareness and resources.

Conclusion
A myriad of health equity initiatives are taking place in Canadian paediatric tertiary care centres, which are evolving.
28 Lost in Translation: Canadian Paediatric Resident Education and Practice of Clinical Translation Services
Authors: Peters Sarah , Carwana Matthew , Peebles Erin 
Published: September 2023

Abstract

Background
Canadian paediatric residents provide care to many families with non-English or French language preferences (NEFLP). Lack of communication in a family’s preferred language is inequitable and results in inferior care. Professional medical interpreters offer a route to enhanced understanding and safety. There is no data available about Canadian paediatric residents’ use of interpreters, making it difficult to identify gaps in practice or develop targeted interventions to improve patient experience.

Objectives
An anonymous, 19-item survey (REDCap) was designed to evaluate: (1) interpreter services available in paediatric training centers; (2) resident perception of their ease of access, utility, and value; and (3) barriers and drivers to interpreter use. This survey represents the first collection of data from Canadian paediatric residents about translator services.

Design/Methods
Eligible participants included all paediatric residents enrolled in an accredited Canadian paediatric training program. The survey was distributed by email and available for a three-month period. This project was reviewed and considered within the category of quality improvement and thus exempt from formal review by the hospital ethics committee. Descriptive statistics were performed in STATA v15.1.

Results
122 residents (approximately 19% of eligible participants) responded. Approximately 40% reported no previous training in interpreter use, and 60% desired more training. Interpreter services are widely available but remain underused in a variety of clinical situations: interpreters are most often used during informed consent (98% ‘mostly’ or ‘always’), family meetings (97%), and history-taking (86%), and least often during physical examinations (41%) and bedside rounds (38%). Residents are more likely to use an interpreter if access is easy (97% ‘more likely’ or ‘likely’) or if there is extra time for the encounter (78%). Most residents (85%) felt they provide better care to patients who share their primary language (English or French), compared with families who prefer other languages.

Conclusion
Residents are more confident in their clinical and communication skills when working with families who share their primary language compared with NEFLP families, even when an interpreter is present. Our findings suggest that residents lack the training and confidence to provide equal care to families with varying language preferences. Paediatric training programs should develop curriculum content that not only targets safe and effective interpreter use, but also reviews non-spoken aspects of cultural awareness and safety.
32 Risk Factors for Iron Deficiency in Formula-fed very Preterm Infants: A Population-based Study from Nova Scotia
Authors: Power Grace , Stratas Alexandra , Landry Carmen , Morrison Lisa , Kulkarni Ketan , Campbell-Yeo Marsha , Singh Balpreet , Higgins Michelle , Ghotra Satvinder 
Published: September 2023

Abstract

Background
Iron prophylaxis is routinely recommended for preterm infants, as they are vulnerable to develop iron deficiency (ID). Recent work from our group has demonstrated that despite early iron prophylaxis, ID is common in very preterm infants (VPI), with an incidence of 32% at 4 to 6 months corrected age (CA). Additionally, ID is more prevalent in exclusively formula-fed (FF) VPI compared to infants who are exclusively or partially breast-fed.

Objectives
To explore the risk factors associated with ID in the FF infants.

Design/Methods
A retrospective population-based cohort study was conducted using a provincial database. All VPI born in Nova Scotia from 2005 to 2018 who were exclusively fed with iron-rich formula (&gt;10 mg/L) at 4 to 6 months CA were included. Information about formula type, iron intake from formula, and supplemental iron therapy at 4- to 6-month follow-up was extracted, as were neonatal variables. ID was defined as serum ferritin &lt;20 and &lt;12 mcg/L at 4- and 6-months CA, respectively.

Results
ID was present in 36.8% (105) of 285 FF infants. Table 1 shows key characteristics of ID and non-ID FF infants. Mean gestational age and birth weight were lower in the ID group. More babies in the ID group received blood transfusion (Odds:1.1-3.0). Other maternal and neonatal variables were comparable between the groups. ID children did not have a lower iron intake than non-ID children.

Conclusion
Lower gestational age, lower birth weight, and need for blood transfusions increased the risk of ID in FF infants. Optimal iron supplementation in this population should be guided by a risk-adapted strategy.