bluuebunny/crossref_metadata_2025_split huggingface dataset:
33 Gluten-free Diet Knowledge and Adherence in Adolescents with Celiac Disease: A Cross-sectional Study
Authors: Pohoreski Katherine , Horwitz Simonne , Gidrewicz Dominica 
Published: September 2023

Abstract

Background
Adolescents with celiac disease (CD) are at risk for non-adherence to the gluten-free diet (GFD). Knowledge of the GFD may impact adherence.

Objectives
To examine the relationship between knowledge and adherence to the GFD in a local population of adolescents with CD. Secondary objectives were to identify information sources used to learn about the GFD and to compare adolescent and parent knowledge of the GFD.

Design/Methods
Adolescents (12-17 years) with CD and their parents from local paediatric gastroenterology clinics completed an online survey containing a knowledge assessment (Gluten-Free Diet Quiz [GFD-Q]), validated adherence scale, GFD information sources, and demographic/clinical information. GFD-Q scores were categorized as “sufficient knowledge” based on correctly identifying: 3/3 gluten-containing foods, at least 4/7 gluten-free foods, and at least 4/7 foods that may contain gluten. Otherwise, scores were termed as indicating “insufficient knowledge”.

Results
Of 40 adolescents, 15/40 (37%) had sufficient knowledge and 25/40 (63%) had insufficient knowledge. Within the insufficient knowledge group, 14/25 (56%) did not correctly identify enough allowed, gluten-free foods. Parents scored higher on the GFD-Q (67% with sufficient knowledge). Adolescents reported overall adherence to the GFD (88%), with adherence similar between sufficient and insufficient knowledge groups (80% vs. 92%). Most helpful information sources include physicians, another person with CD, parent(s), and Google (online search engine). Apps were infrequently used (20% of adolescents).

Conclusion
Adolescents report good adherence, but struggle with knowledge of the GFD, particularly in identifying gluten-free foods. Further research is required to explore GFD educational tools, including mobile apps and dietician-led teaching sessions.
34 Using Spatial Analysis to Identify Access to IFHP-registered Paediatric Providers in Ontario
Authors: Abeytunge Kawmadi , Alemayheu Gelila , Miller Michael , Suleman Shazeen , Gunz Anna 
Published: September 2023

Abstract

Introduction/Background
Compared to non-refugees, child refugees face a wide array of health disparities, including higher levels of nutritional deficiencies, infectious diseases, and mental illness secondary to experienced poverty, trauma, and migration. After migration, refugee families continue to face health inequities, necessitating access to health care. In Canada, the Interim Federal Health Program (IFHP) provides temporary health care benefits to refugees and refugee claimants who are ineligible for provincial or territorial health insurance. The program requires healthcare providers to register to be reimbursed for care provided. However, physicians are not required to register for IFHP, leading to fewer providers.

Objectives
This study aimed to map where IFHP-registered primary care physicians (PCPs) and paediatricians live and work in Ontario, relative to where IFHP-insured patients live, to identify geographic accessibility of primary healthcare services for paediatric refugee populations.

Design/Methods
We performed spatial analysis using ArcMap (version 10.8.2), a geographic information system (GIS). The practice location of PCPs and paediatricians registered for IFHP as of December 2021 were geocoded and the percent of IHFP provider per population for each Census Tract (CT) was calculated. Refugee populations eligible for IFHP in Ontario by CT, as identified by the 2016 Canadian Census, were calculated as percentages and per 10,000 population, and linked to geospatial data for comparison. Ratios of IFHP providers to refugees were calculated for each CT.

Results
At the time of data collection, there were 481,710 documented refugees living in Ontario, and 11,854 IFHP-registered paediatricians or PCPs. Toronto, Windsor, and Kitchener-Waterloo had the largest percentages of refugees per population (5.4%, 5.1%, and 4.6%, respectively), while Toronto, Hamilton, and London had the highest percentage of IFHP providers per population (0.13%, 0.11%, and 0.09%, respectively). Generally, CTs with the highest proportion of refugees had more IFHP-registered providers, and rural areas had the fewest number of both refugees and IFHP-registered providers. However, there were 941 CTs recognized across Ontario with identified refugee populations but no registered IFHP providers. The CTs with the highest ratio of IFHP providers to refugees were in Toronto and Ottawa (3.9, 2.0 in Toronto, and 2.1 in Ottawa, respectively).

Conclusion
While some regions with large refugee populations have registered IFHP PCP providers, there are regions that are relative IFHP provider-deserts for resident refugees. Identifying areas where geographic barriers are likely to exist in Ontario is necessary to improve accessibility of existing services and could help reduce healthcare inequities faced by the refugee population.
35 Estimating the Impact of Pregnancy and Childbirth Interventions Coverage on Neonatal Survival during the COVID-19 Pandemic in Nepal
Authors: Dharel Dinesh , Paudel Deepak , Muhajarine Nazzem 
Published: September 2023

Abstract

Background
The indirect impact of the COVID-19 pandemic on neonatal survival, especially in a resource-constrained and yet previously well-performing nation and in terms of reductions in maternal and neonatal mortality rates, is of global health interest.

Objectives
We estimated additional newborn lives saved by pregnancy and childbirth interventions during the COVID-19 pandemic in Nepal.

Design/Methods
We used an open-access linear deterministic model, Lives Saved Tool (LiST), to estimate additional newborn lives saved in a year, based on the change in coverage of specified pregnancy and childbirth interventions from the previous year. We kept the rest of the interventions and the effectiveness values unchanged from the ‘default’ in the LiST model. We ran LiST projections based on coverage changes of three or more antenatal care visits and institutional delivery using: (i) ‘actual’ coverage rates reported by health facilities and published in the government’s annual reports; and (ii) ‘target’ coverage rates from the Nepal Every Newborn Action Plan. In those two scenarios, we compared the estimates of additional lives saved in the last three years.

Results
The number of additional newborn lives saved (with a 95% confidence interval) in a year based on ‘actual’ versus ‘target’ intervention coverage rates varied considerably during the three years of the COVID-19 pandemic: 124 (95% CI: 85,177) vs 115 (78,163) in the year 2020; 83 (57, 118) vs 226 (155,323) in 2021, and 228 (156,323) vs 333 (228,471) in 2022. The top four interventions during childbirth would contribute to 70% (304 of 435) of additional lives saved, based on ‘actual’ coverage rates, compared to 87% (588 of 674) based on the ‘target’ coverages. Neonatal resuscitation saved the most newborn lives (91 vs 178), followed by thermal protection (77 vs 148), clean cord care (72 vs 138), and assisted vaginal delivery (64 vs 124). Prematurity, birth asphyxia, and sepsis are the top three causes of lives lost, contributing to around 72% of neonatal mortality, with estimated neonatal mortality rates of 19.46, 19.53, and 19.28 per 1000 live births in the years 2020, 2021, and 2022 respectively.

Conclusion
A one-third reduction in estimated additional newborn lives saved in the year 2021 compared to 2020, and a significant difference noted that same year on estimates based on ‘actual’ versus ‘target’ coverage rates of antenatal care and institutional delivery in Nepal, may reflect an indirect impact of reduced coverage of pregnancy and childbirth interventions on neonatal mortality during the peak of the COVID-19 pandemic.
36 Quality Improvement Integrated Kangaroo Mother Care (QIiKMC)-Development with Evidence-based Practice for Improving Quality (EPIQ) to Improve Learning and Implementation
Authors: McMillan Doug , Singhal Nalini , Kyoyagala Stella , Niermeyer Susan , Kabirigi Julieth , Keenan William , KC Ashish , Kamaluddeen Majeeda , Aziz Khalid 
Published: September 2023

Abstract

Introduction/Background
Kangaroo Mother Care (KMC) improves outcome for small newborns, but implementation has been slow. This lag may be associated with lack of short, effective learning programs for healthcare workers, and limited ability to overcome barriers to KMC program development.

Objectives
To develop a practical learning program for KMC with focus on facilitating healthcare workers assisting the learning of mothers and other family members in KMC care of small babies. To integrate KMC with quality improvement to assist healthcare workers overcome barriers to implementation and improve practice.

Design/Methods
Six neonatologists, with other global experts, developed as simulation-based, interactive, 12-contact-hour learning program with virtual pilot testing in Uganda, Tanzania, and Nepal, prior to implementation in Mbarara Regional Referral Hospital in Uganda. Revisions in QIiKMC course content and integration with quality improvement were accompanied by development of A KMC Readiness, Survey, Knowledge and Confidence Check, Parent Information, and Course Evaluation, with all components available at www.cnf-fnc.ca.

Results
Thirty-three nurses and physicians increased knowledge scores from 79% to 88% post-learning. 77% indicated the course was useful or very useful, appreciating “The link between EPIQ and KMC in identification and solving problems” and the “Usefulness of family involvement in caring for the newborn in the hospital and home”. Participants indicated preferences for face-to-face learning and more time for hands-on practice. KMC for small babies increased from 0% to 65% (by August-October 2022). Length of hospital stay decreased by 5 days. Government increased KMC beds from 4 to 8. Staff reported increased job satisfaction along with increased quality improvement activities. Family members in addition to mothers were involved (especially with multiple births or if the mother was ill). Families helped other families with learning. One father reported that “When my baby grows up, I will let him know that it was my warmth which kept him alive”.

Conclusion
Development of a short, practical KMC learning program was feasible. Integration with quality improvement was empowering and impactful.

Acknowledgements
Funding from the Royal College of Physicians and Surgeons of Canada and a Rotary Global Grant is appreciated.

Potential competing interests
Funding for learning program development was received from the Royal College of Physicians and Surgeons of Canada. Funding for KMC implementation in Uganda was supported by a Rotary Global Grant.
Poster ID: 39 How is Paediatric Inpatient Care in Canadian Hospitals Structured to Respond to the Needs of Children with Medical Complexity?
Authors: Miandoab Sadaf Ghanbari , Dewan Tammie , Buchanan Francine , Gaucher Nathalie , Gill Peter , Lim Audrey , McKinnon Alexandra 
Published: September 2023

Abstract

Background
Children with medical complexity (CMC) have diverse medical diagnoses and the following characteristics: multisystem disease, functional limitations, high care needs, and high healthcare utilization. CMC have intensive inpatient resource use with associated high healthcare costs. Best practices and service delivery models to guide inpatient care of CMC are not yet established and likely vary considerably among institutions.

Objectives
The objective of this study is to describe the availability and organization of resources for CMC during inpatient care across Canadian paediatric hospitals and assess how these services are adapted to the specific needs of CMC.

Design/Methods
This environmental scan was conducted as a cross-sectional, researcher-administered virtual survey. The instrument was developed based on a literature review of inpatient complex care and consensus among a panel of content experts. The survey was pilot tested with two complex care physicians and one with expertise in questionnaire development. The survey was available in both English and French.
Survey participants were identified through snowball sampling within the Canadian Paediatric Inpatient Research Network (PIRN) with the aim of identifying a key informant from each paediatric hospital. Consistent members of the research team administered survey questions to participants via Zoom, and responses were entered into the Qualtrics platform. Quantitative survey responses were analyzed using univariate descriptive analysis. Qualitative responses were categorized and described for comparative purposes.

Results
Ten interviews were conducted representing ten different paediatric hospitals. Although nine had established complex care programs, only one of these had a specific inpatient care team for CMC. The physician-to-patient and nurse-to-patient ratios were the same for CMC and non-CMC patients. All sites had some form of standardized documentation to support inpatient care of CMC, but each had different elements and purposes. Only two sites had conducted formal evaluation of their inpatient program for CMC. Key informants rated their hospital’s ability to meet the specific inpatient needs of CMC as a 6.5 out of 10 (on average), with a range of 4-8.

Conclusion
These results suggest a relative lack of inpatient resources directed to CMC, with a high proportion of sites having a complex care program but with few that include a dedicated inpatient team. Further, there is a lack of standardization across the country in terms of documentation and best practices. Key informants perceive room for improvement in inpatient care at their sites. Future studies will identify evidence-based best practices that can be further evaluated and spread.
40 Analgesia in Sickle Cell Disease: Do We Give the Right Dose? A Systematic Review of Pharmacokinetic Studies
Authors: Kleiber Niina , Czech Ann-Sophie , Bernier Gabrielle , Pastore Yves , Doré-Bergeron Marie-Joëlle , Trottier Evelyne D , Théorêt Yves , Autmizguine Julie , Pincivy Alix 
Published: September 2023

Abstract

Background
Children with sickle cell disease (SCD) suffer from lifelong episodes of unpredictable acute pain that alter their quality of life. Despite prompt pain treatment, hospitalization is often required for pain management. SCD is a multisystemic disease affecting organ function (e.g., renal hyperfiltration, change in liver blood flow). Altogether, these changes could alter pharmacokinetics (PK).

Objectives
We hypothesize that SCD leads to changes in PK of analgesics potentially contributing to treatment failure using regular medication doses.

Design/Methods
A systematic literature review to describe the current evidence on the effect of SCD on analgesic disposition in children was performed by a librarian on 5 databases from inception until February 2021 and independently assessed by two reviewers. All full text articles, including PK data in children with SCD, were included. The reported differences in PK parameters between children with and without SCD were examined.

Results
Among 5170 retrieved abstracts, 84 full text articles were reviewed, and 7 studies were included on 128 patients. Studied drugs were morphine (IV and PO), lidocaine (IV), methadone (IV) and rofecoxib (PO). In children with SCD, clearance of IV morphine was 42-61% higher compared with non-SCD controls. Hepatic metabolism of lidocaine was decreased in children with SCD compared to healthy controls. No significant PK changes were noted for methadone and rofecoxib compared with non-SCD controls.

Conclusion
SCD leads to significant changes in PK of analgesics, but data are scarce. Increased clearance of morphine suggests that higher doses may be needed in children with SCD. Data on commonly used analgesics like acetaminophen, ibuprofen and ketamine are critically missing. Dosing of analgesics adapted to SCD are needed and may potentially improve pain control in this population.
41 Evaluating Immunization Status and Barriers to Immunization for Patients Admitted to the Stollery Children's Hospital
Authors: Lissinna Brittany , Gilbert Chelsea , Isaac Calla , Mian Qaasim , Forbes Karen 
Published: September 2023

Abstract

Introduction/Background
Routine immunization is an effective public health intervention. Despite this, immunization coverage in Alberta remains below national targets. While vaccine hesitancy is a frequently cited barrier, underimmunization is likely multifactorial. Previous research has shown that hospitalization presents an opportunity to “catch-up” children who are underimmunized. Unfortunately, this is not readily available at the Stollery Children’s Hospital (SCH), a paediatric tertiary care facility serving a large catchment area.

Objectives
The primary objective of this study was to assess the immunization status of children admitted to paediatric clinical teaching units (CTUs) at SCH. Our secondary objective was to assess potential barriers caregivers face while attempting to immunize their children.

Design/Methods
Between July 2021 and October 2022, we prospectively gathered the immunization status of children aged 2 months to 18 years admitted to paediatric clinical teaching units (CTUs) at SCH. Two hundred and fifty children and their caregivers were enrolled in the research study. Demographic data and immunization records were documented, and immunization status of each participant was classified as up-to-date or not-up-to-date based on the Alberta Routine Childhood Immunization Schedule. Caregivers completed a standardized survey, Searching for Hardships and Obstacles to Shots (SHOTS), to assess potential barriers they face while attempting to immunize their children, including three subscales (access to shots, concerns about shots and importance of shots).

Results
Of the 250 children enrolled, immunization data was available for 240 children. Of these, 142 (59%) were up-to-date on their immunizations. Assessment of demographic data revealed no difference in immunization status between urban and rural addresses. When evaluating barriers that families face when approaching immunization, concerns about immunization were most commonly cited as barriers for all patients. However, caregivers whose children were not up-to-date on immunizations scored higher on all subscales compared to those whose children were up-to-date.

Conclusion
The immunization status of children admitted to paediatric CTUs at SCH falls far below national targets. Due to logistical issues, it is challenging to access routine immunizations during hospitalization. Caregivers of children who are underimmunized also identify a higher rate of barriers to immunization. These underimmunized patients represent a missed opportunity, and improving access to routine immunization while in hospital could improve the overall immunization rates for both hospitalized children and the broader community.
44 Ceftriaxone Prescribing Patterns in an Outpatient Hospital Setting: A Quality Improvement Study
Authors: Wong Kimberly , Papenburg Jesse , Evangeliou Helena 
Published: September 2023

Abstract

Background
Ceftriaxone is a commonly administered antibiotic in paediatric medical day hospitals (MDH) for certain conditions where it may be considered first-line. Its long half-life permits once-daily dosing, thus potentially avoiding inpatient admission. However, administration of ceftriaxone requires intravenous line insertion, daily follow-up, and time spent by the family. There is a perception among healthcare providers in our tertiary hospital that ceftriaxone use is frequently inappropriate in the outpatient setting, and that more narrow-spectrum oral agents could be prescribed instead.

Objectives
Our primary objective was to evaluate the appropriateness of ceftriaxone use according to centre-specific first-line indications, in children between the ages of 3 months and 18 years in the MDH.

Design/Methods
Data were collected retrospectively for one winter season (Nov 2, 2019 to Jan 11, 2020) and one summer season (June 2, 2020 to Sept 25, 2020). All patients initially referred by the emergency department (ED) to the MDH were reviewed. Inclusion criteria included children (age 3 months to 18 years) who received ceftriaxone in the MDH or the ED. Patients with pre-existing immunodeficiency were excluded. Appropriateness was assessed according to the empiric antimicrobial guide available at our centre. In cases where ceftriaxone appropriateness was unclear, a detailed chart review was conducted by two parties including a resident and a staff trained in paediatric infectious diseases.

Results
Among eligible patients referred to the MDH from the ED (n=196), ceftriaxone was inappropriate in 113 cases (57.7%). Inappropriateness was more prevalent in the summer than the winter (76% vs 41.3%, p&lt;0.0001). The most frequent inappropriate indications for ceftriaxone were: cellulitis with a skin portal of entry, including pre-septal cellulitis (54.0%); non-severe pneumonia (11.5%); and acute lymphadenitis (11.5%). Cellulitis was more prevalent in the summer (38.7% vs 16.3%), whereas pneumonia was more prevalent in the winter (20.2% vs 2.2%). Ceftriaxone was almost always initially prescribed in the ED (95.4%), and was continued in 164/187 (87.7%) of first MDH visits. An average of 2.9 doses of ceftriaxone was given per patient. Only one patient was documented to be initially unwell looking in the ED, and 50% were afebrile.

Conclusion
Ceftriaxone is overused in the MDH at our institution, largely due to skin and soft tissue infections and non-severe pneumonia. Targeted antimicrobial stewardship interventions to reduce ceftriaxone use in both the ED and MDH could improve the patient experience (less broad-spectrum antibiotics, less invasive procedures) and the efficient use of the MDH.