bluuebunny/crossref_metadata_2025_split huggingface dataset:
19 Characterization of Neurodevelopmental Comorbidities within a Paediatric Population with a First Epileptic Seizure
Authors: Leduc Bertrand , Diadori Paola , Major Philippe , Gagné Jennifer , Bitton Jonathan , Aboulamer Soumia , Beetz Gabrielle 
Published: September 2023

Abstract

Background
Epilepsy is the most common paediatric neurological disorder. An estimated 4% of the general population will have an unprovoked epileptic seizure at least once in their lifetime. Of these, about 40% will experience a recurrence within two years. The International League Against Epilepsy (ILAE) established that one part of the definition of epilepsy was the onset of a first seizure with a recurrence risk of more than 60% over 10 years. However, except for epileptiform abnormalities and a structural-metabolic etiology present on the electroencephalogram (EEG), very few known factors are consistently associated with first epileptic seizures.

Objectives
Our study’s objective was to characterize neurodevelopmental comorbidities, namely attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), anxiety, depression, gross motor delay and language delay, in patients following a first epileptic seizure as compared to healthy controls.

Design/Methods
Children referred in neurology for a first suspected epileptic seizure, between June 2016 and June 2018 at the Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), underwent EEG and neurological evaluations. For screening of comorbidities, parents completed age-appropriate M-CHAT-R/F, SCQ, ASQ-3, SCARED, and CES-DC questionnaires via a web platform adapted from CHADIS. Questionnaire scores were adjusted for age and sex and analyzed via a Student’s t-test. The prevalence of comorbidities was analyzed via a chi-square statistical test.

Results
A total of 72 subjects aged between 1 month and 18 years (42 males, 30 females) were enrolled in the study. Patients with a first epileptic seizure (n=37) showed significantly more comorbidities compared to the healthy subjects (54% vs. 31%, p&lt;0.05). Patients with a first epileptic seizure had significantly more language delay (50%, p=0.015), ADHD (45%, p=0.008), and a significantly higher score in the Social Communication Questionnaire (SCQ) (p=0.03), compared to healthy subjects.

Conclusion
Our results confirm the increased rate of comorbidities in children with a first epileptic seizure and, thus, the importance of concomitant screening for those disorders at the time of the initial presentation.
22 Families’ Experiences with Autism Service Navigation and Mobile Application-based Support
Authors: Young Elizabeth , Jegathesan Thivia , Nallathamby Shanthiya , Wagner Rachel , Minhas Ripudaman , Penner Melanie 
Published: September 2023

Abstract

Background
Navigating services following an autism spectrum disorder (ASD) diagnosis is a challenging and lengthy process. Families of children with ASD increasingly experience difficulty locating and accessing services, leading to the inaccessibility of care. These difficulties were further exacerbated by COVID-19 and little is known about families' experience navigating services during the pandemic. Given the complexities of accessing publicly funded developmental services and the lack of a comprehensive platform to navigate available services, prior to the pandemic our research team developed a mobile application, My Autism Passport (MAP), to assist families in identifying publicly available ASD services. Our goal was to determine whether a mobile application would provide families with greater self-efficacy during these challenging times.

Objectives
The primary objective of our study was to determine the impact of MAP on caregiver self-efficacy.

Design/Methods
A randomized controlled trial of 34 caregivers of children under 6 years of age who were given a new diagnosis of ASD in the last year were recruited into the study. 17 were randomized to receive MAP. Access to ASD services and parent self-efficacy scores were collected via questionnaires at baseline and then at 6 months from recruitment in both groups. Self-efficacy was measured using the Parent Empowerment and Self-Efficacy Measurement (PEEM).

Results
Our study consisted of an ethnically diverse group of participants with varying socioeconomic levels. At baseline, participants indicated an overall mean PEEM score of 131.8 (±28.2) in the control arm, and 138.5 (±23.3) in the App arm at the time of diagnosis (p-value 0.6149). At 6 months following ASD diagnosis, the overall score was 123.2 (±35.7) in the control arm, and 137.3 (±33.3) in the App arm (p-value 0.4413). There was a trend towards decreasing feelings of self-efficacy in the control group compared to those with the App who had a stable self-efficacy score.

Conclusion
Our study indicates that the use of a mobile app to assist service navigation may be helpful for families in self-navigation for autism services. Data collection and analysis are ongoing for one-year post-diagnosis.
27 EDI Practices Amongst Academic Leaders at a Tertiary Paediatric Centre
Authors: Johnson Natasha , Johnson Kassia , Kam April , Khan Sarah , Wahi Gita , Lacy Megan 
Published: September 2023

Abstract

Background
Our university’s strategic approach to Equity, Diversity and Inclusion (EDI) includes institutional capacity and commitment. Embedded within this pillar is the establishment of “systems, structures and policies that sustain EDI commitments through leadership, governance and accountability”.
1.Objectives: To ascertain baseline EDI practices of Division Leaders and the Department Executive Team
2.To identify prioritized training/learning needs early in the tenure of the inaugural Associate Chair, EDI

Design/Methods
An anonymized, 10 question electronic survey was distributed to division leads and executive team members with the Department of Paediatrics.

Results
An electronic survey was distributed to 22 people and 14 responded (64% response rate).
Only 21% of leaders included a land acknowledgement at the beginning of their division, portfolio, or committee meetings. Reasons for not doing so included:
• Meetings are informal or have few people
• Worried about tokenism/checking a box
• Had not thought to do so
29% of leaders have a standing “EDI matters” agenda item for their division, portfolio, or committee meetings. Reasons for not doing so included:
• Attempting to incorporate EDI principles into work
• Addressing EDI items as they occur
• Unsure how to engage in meaningful action
• Had not thought to do so
The majority of leaders who responded, 79%, completed bias education and/or training. All the respondents want more, or specific, EDI training for their division(s) or portfolio(s). Racism was identified as the #1 equity issue urgently impacting divisions or teams. Other priority areas identified included: 2SLGBTQIA+, gender equity, Indigenous reconciliation, and employment bias. Other themes that were raised included:
• Equitable healthcare access
• Representation at decision-making tables
• Gender bias impact on career and work opportunities
• Bias in the workplace
• Becoming an antiracist organization
• Engaging everyone in antiracist work
• Systemically embedding EDI principles
• Equitable opportunities and support for all employees
That 36% of department leaders did not respond to our brief EDI survey may need to be explored further.

Conclusion
Most leaders are not routinely doing land acknowledgments or incorporating EDI into agendas as a standing item. All expressed a desire for more EDI training. Survey responses informed priorities for the first term of the Inaugural Associate Chair, EDI. An EDI-focused Grand Rounds Series and an EDI SharePoint site were created. Leaders are encouraged to make EDI awareness integral to daily tasks from initial recruitment. Our Anti-Racism Coalition’s version of the Power Flower (Figure 1) was shared to enhance awareness of various power differentials at play.
29 Assessing Paediatric Trainees’ Confidence in Providing Culturally Responsive Care to Patients
Authors: Chen Anna , Blatman Zachary , Chan Amy , Hossain Anna , Niles Chavon , Atkinson Adelle , Narang Indra 
Published: September 2023

Abstract

Background
Extensive data consistently demonstrate inequities in access and delivery of healthcare for patients from historically marginalized populations, resulting in poorer health outcomes. To address systemic oppression in healthcare, it is necessary to embed principles of equity, diversity, and inclusion (EDI) within medical education. Currently, limited data exist regarding paediatric trainees’ interest in EDI curricula and confidence in applying this knowledge to provide culturally responsive care.

Objectives
To assess paediatric trainees’ confidence in applying EDI knowledge to provide culturally responsive care to children and youth from historically marginalized communities.

Design/Methods
An anonymous online survey was distributed to paediatric trainees at a Canadian paediatric tertiary care centre during the 2021/22 academic year. Closed-ended questions used a Likert scale to assess respondents’ confidence and interest in providing culturally responsive care to patients. Open-ended questions explored trainees’ perceptions of effective EDI learning modalities. Quantitative data was summarized using descriptive statistics. Descriptive content analysis was used to highlight themes within qualitative data.

Results
116 paediatric trainees completed the survey, of which 72/116 (62%) were subspecialty residents/fellows and 44/116 (38%) were core residents. Nearly all respondents indicated importance (mean 97%) and interest (mean 95%) in learning about providing culturally responsive care to patients from historically marginalized communities. However, many trainees lacked confidence in their knowledge of providing culturally responsive care (mean 51%) and applying their knowledge in clinical practice (mean 53%). Respondents identified direct clinical exposure through rotations, immersive experiences, and continuity clinics as effective EDI teaching modalities. Identified barriers included time constraints in the clinical environment, burnout, and lack of exposure to diverse patient populations.

Conclusion
Most paediatric trainees want to provide culturally responsive care to patients from historically marginalized communities, but do not feel confident in their knowledge to do so. These study findings will be utilized to develop and implement an enhanced EDI education curriculum for both core trainees, as well as subspecialty residents and fellows, across the Department of Paediatrics.
30 Promoting Child and Youth Rights Literacy and the United Nations’ Convention on the Rights of the Child (UNCRC) for Equity-deserving Populations: A Multi-Partner, Mixed Methods Pilot Study
Authors: Grover Sanya , Binda Catherine , Lau Will , Beevor-Potts Amy , Bondi Lauren , Gill Sabrina , Ritland Lisa , McFadden Alysha , Bland Clea , Duffy Damian , Carwana Matthew , Hodgson Kate , Vaghri Ziba , Loock Christine 
Published: September 2023

Abstract

Background
The UNCRC outlines the rights of children and youth to develop their greatest potential. These rights provide a framework for a child-centred approach in paediatric clinical practice and are associated with improved patient outcomes and experiences. While these rights are increasingly acknowledged globally, more work is needed within clinical settings to adopt this rights-based approach. A pilot survey was developed in partnership with an equity-deserving urban youth recreation centre and youth with chronic health conditions from a provincial paediatric tertiary care teaching hospital’s Youth Advisory Committee (YAC) regarding their knowledge of, and access to, the UNCRC.

Objectives
1) To identify urban community youth knowledge of, and access to, UNCRC; 2) To identify and compare YAC knowledge of, and access to, UNCRC.

Design/Methods
Ethics approval was obtained. A survey developed to facilitate UNCRC discussions was presented to the urban community youth, iteratively from 2020 to 2021. Participants were recruited using convenience snowball sampling. Zoom dialogues between the research team and YAC members were held to adapt the survey to YAC context. The survey was completed by YAC members on Qualtrics from May to August 2022. Demographic information and survey results were analyzed using descriptive statistics.

Results
57 participants completed the survey, including 18 youth, 16 caregivers, and 11 staff members from the community, and 11 youth and 1 staff member from YAC. The median ages of urban and YAC youth were 16.4 years and 23 years respectively. Prior to the study, 70% of youth participants did not know, or only sort of knew that the UNCRC existed. Both urban youth and YAC reported that children aged 0 to10 and 11 to 14 have the most access to article 31 (rest and play). However, urban youth reported that 15 to24-year-olds have the most access to article 24 (health and health services), whereas YAC reported article 12 (respect for children’s views) for this age group. Both youth groups reported that children and youth of all ages have the least access to articles 28 and 29 (education), article 12 (respect for children’s views), and article 23 (support for children with disabilities).

Conclusion
A lack of knowledge of the UNCRC was prevalent in youth from both an urban community and tertiary care hospital, indicating a need for increased dialogue among this community, clinicians, and the healthcare system. These results will also inform patient advocacy communities on gaps in knowledge and access to empower advocacy around child rights.
38 Key to Success to Improve Best Practices: A Nurse Champion to Increase Institutional Use of Procedural Pain and Distress Management Strategies
Authors: Trottier Evelyne D , Laforce Patricia , Paquette Julie , Doré-Bergeron Marie-Joelle , Loemba Sarah , Lacroix Annie , Grou Benedicte 
Published: September 2023

Abstract

Background
Procedural pain and distress management are essential when providing medical care to children. Quality improvement (QI) initiatives need to be developed to improve the knowledge of healthcare providers (HCP), increase their adhesion, and improve care. The Tout doux project is an institutional QI initiative aimed at improving procedural pain management. Since studies have shown that nurse champions are facilitators in implementing best practices, a procedural pain nurse champion (PPNC) was a key part of the Tout doux QI initiative.

Objectives
The aim of this project is to assist HCP in the reduction of children’s procedural pain and distress by increasing their use of procedural pain and distress management strategies with the support of a PPNC.

Design/Methods
For each sector, the PPNC organizes meetings with medical/nursing heads to coordinate and adapt local deployment and helps create a local, multidisciplinary Tout doux committee. Afterward, the PPNC collects data through audits of different procedures, on every shift, to assess the baseline use of pain management strategies. Those results are presented to the local pain committee to determine improvement needs. Then, HCP receive mandatory training through an e-learning module or official lectures to strengthen their knowledge and discuss barriers based on the traditional “4P” approaches to reducing procedural pain: Prevention, Psychological, Physical, and Pharmacological strategies. For 2 months, the PPNC gives field support to the team by providing direct coaching during procedures, helping to guide the local Tout doux committee, and consolidating new HCP knowledge into practice. After this period, audits are completed to evaluate these combined strategies.

Results
Between June 2021 and October 2022, the Tout doux project was deployed in 13 sectors. More than 400 audits were conducted pre-deployment. To date, more than 150-post deployment audits have been realized in 6 sectors. Results show improvement in the use of combined procedural pain and distress management strategies: from 160/234 (68%) of procedures using two or more strategies before the deployment, to 132/150 (89%) of procedures post-deployment (Table 1). To this day, more than 1500 HCP have received training throughout CHUSJ units and clinics.

Conclusion
Deploying the Tout doux project on procedural pain and distress management improved the combined use of coping strategies with the support of a dedicated PPNC. The next step will be to ensure its dissemination throughout the institution and further assess the long-term outcome on patients.
42 Enacting Meaningful Change in the Face of Adversity – Use of a Sentinel Event to Pilot the Creation of a Rapid Response System in a Tertiary Paediatric Care Centre
Authors: Naguib Mariam , Iraqi Hajare , Lehr Anab Rebecca , Rich Catherine , Feder Joshua , Farnesi Biagina-Carla 
Published: September 2023

Abstract

Introduction/Background
Although rare, in-hospital paediatric mortality occurs at a rate of 12.66 per 1000 admissions. Delayed recognition of clinical deterioration is a modifiable factor in such adverse events. In paediatric patients, subtle changes in vital signs often precede acute deterioration and provide an opportunity for early intervention and prevention of further deterioration. Based on this rationale, rapid response systems (RRS), which include a critical care response team (CCRT) and a Paediatric Early Warning Score (PEWS), have been established to facilitate the detection of clinical deterioration and mobilize resources for timely treatment. There is evidence that RRS can significantly decrease inpatient clinical deterioration events and PICU utilization.

Objectives
At our institution, serious patient safety events identified system failures in recognition, communication, and escalation of care in response to clinical deterioration. The root cause analysis led to a quality improvement and patient safety initiative to implement an RRS at our tertiary paediatric care centre.

Design/Methods
Process implementation of this pilot project required consultations with key stakeholders and designation of unit champions to mobilize resources and promote buy-in. Based on other successful implementation strategies, we adopted the Modified Brighton PEWS, defined a response algorithm, created bedside tools, constructed an interdisciplinary CCRT, and organized simulation activities to implement the new process. We used the Plan-Do-Study-Act method to carry out change based on weekly feedback from frontline workers. To assess the feasibility and acceptability of this initiative, all CCRT activations during the pilot phase were reviewed and a survey was distributed pre- and post-implementation. The number of code blues and mortality data will also be measured.

Results
The pilot period spanned June to September 2022 on our medical inpatient unit. Average response time to CCRT activation was 12 minutes (IQR 7-13.5), a median of three therapeutic interventions were required per activation, and 33% of activations resulted in PICU admissions. Among the 27 post–implementation survey respondents, 87% identified CCRT as a useful addition to optimize care and address patient safety concerns. Qualitatively, it has created a shared safety culture and empowered junior members of healthcare teams to escalate care.

Conclusion
This quality improvement initiative pilot study has demonstrated feasibility and acceptability of RRS implementation with a positive impact on patient safety culture and earlier detection and intervention for deteriorating patients. Further prospective comparative clinical benefits and cost-benefit analyses are needed to support hospital-wide implementation.
46 Association of Empiric Antibiotic Selection on Clinical Outcomes in Hospitalized Children with Severe Orbital Infections: A Multicenter Cohort Study
Authors: Nguyen Emily , Mahant Sanjay , Cichon Jessica , Borkhoff Cornelia M , Drouin Olivier , Pound Catherine , Quet Julie , Wahi Gita , Bayliss Ann , Vomiero Gemma , Foulds Jessica , Kanani Ronik , Sakran Mahmoud , Sehgal Anupam , Pullenayegum Eleanor , Widjaja Elysa , Reginald Arun , Wolter Nikolaus E , Parkin Patricia C , Gill Peter J , Krueger Carsten 
Published: September 2023

Abstract

Background
Antibiotic selection in children with periorbital and orbital infections is often empiric and regimens vary widely among institutions in their spectrum and inclusion of anti-anaerobic and anti-staphylococcal agents.

Objectives
Currently, there are no national clinical guidelines for antibiotic selection and no studies comparing commonly used antibiotic regimens in orbital infections. We aimed to determine the association of initial empiric antibiotic regimens with clinical outcomes in children hospitalized with severe orbital infections.

Design/Methods
We conducted a multicentre cohort study of children with severe orbital infections admitted to ten hospitals between January 1, 2009, and December 31, 2018. The association between empiric antibiotic regimen in the first 24 hours of hospitalization with length of stay and surgical intervention were assessed with multivariable median regression and multivariate logistic regression, respectively.

Results
Of 1421 patients, 60.0% were male, and mean age was 6.4 years (SD 4.5). Median length of stay was 86.4 hours (IQR 56.9-137.5) and 180 (12.7%) received surgical intervention. The most frequently (23.6%) administered empiric regimen consisted of a third-generation cephalosporin, anaerobic agent, and staphylococcal agent. After adjustment, broad-spectrum empiric antibiotic regimens with dedicated anti-anaerobic and/or staphylococcal coverage were associated with increased length of stay, ranging from an additional 18.4 hours (95% CI, 6.82, 30.0) to 21.5 hours (95% CI, 11.0, 32.0). Only patients with staphylococcal coverage alone had a statistically significant increased odds of surgical intervention (4.45, 95% CI 1.03, 19.2).

Conclusion
In children hospitalized with severe orbital infections, broad-spectrum therapy with or without coverage for staphylococci and anaerobes were associated with similar clinical outcomes in a clinical setting with low methicillin-resistant Staphylococcus aureus prevalence. Clinical practice guidelines are needed to standardize antibiotic recommendations.