bluuebunny/crossref_metadata_2025_split huggingface dataset:
64 A Canadian multicentre survey of family needs when attending the pediatric emergency department
Authors: Rahimi Asa , Ali Samina , Rajagopal Manasi , Ma Keon , Yaskina Maryna , Goldman Ran , Stang Antonia , Beer Darcy , Poonai Naveen , Alqurashi Waleed , Weingarten Laura , Kam April , Principi Tania , Curran Janet , Gardner Katie , Hartling Lisa , Wright Bruce , Plint Amy , Gouin Serge , Schreiner Kurt , Leung Julie , Scott Shannon 
Published: October 2022

Abstract

Background
Parents/caregivers strongly influence their child’s experience in the pediatric emergency department (PED). Understanding their needs can improve families’ PED experience and care.

Objectives
To describe caregivers’ perceived emotional, practical, and informational needs in the PED and how well these needs were met

Design/Methods
This descriptive, cross-sectional survey with medical record review was conducted at 10 Canadian PEDs from October 2018 to March 2020, over a 1-week period every season, for a total of 4 weeks per site. Digital surveys available in English or French were completed by caregivers in the PED and 7 days after their visit. Health literacy was evaluated by the Newest Vital Sign tool.

Results
A total of 2005 caregivers participated; mean age was 37.8 (SD 7.7) years, and 74.3% (1462/1969) were mothers. The mean child age was 5.9 (5.1) years and 51.9 % (1040/2003) were male. Caregivers’ main spoken language was mostly English [72.6% (1425/1964)] or French [10.5% (206/1964)]. Over half of caregivers had a university/professional degree [51.0% (997/1956)]; 37.4% (746/1998) had possible/probable limited health literacy. 77.9% (1132/1454) of caregivers reported that their overall care needs were met. 71.7% (1081/1507) of caregivers reported that their emotional needs were met; they reported most emotional support by doctors [(35.6%, 535/1510)] and bedside nurses [(24.2%, 364/1507)]. The median (IQR) length of stay was 3.9 (2.6, 6.1) hours; 36.7% (546/1487) of caregivers felt they waited ‘too long’, and 77.8% (1158/1489) did not know how long they would have to wait. 11.7% of families were dissatisfied with the care updates provided. A safe PED was the top overall identified practical need [(45.1%, 602/1336)]. Internet access was the most important practical need throughout the visit [(28.1%, 378/1345)], while more space was the most reported [(49.8%, 696/1398)] need in the waiting room. The most desired improvements in the PED were better communication of wait times and delays [(41.1%, 745/1812)], shorter wait times [(38.8%, 699/1801)] and faster diagnosis [(24.9%, 449/1803)].

Conclusion
Almost one quarter of Canadian caregivers report that their overall needs were not fully met when attending the PED. Safety during the PED visit was of utmost importance. Nationally, caregivers value shorter wait times, rapid diagnosis, and better communication about perceived delays. Top practical needs included internet access and more waiting room space. Creating innovative waiting systems, better methods to share wait time information, free internet access, and improved physical spaces could better address identified caregiver needs in the PED.
68 Are Health Equity Rounds (HER) an acceptable format to address education on implicit bias and structural racism in pediatric emergency settings?
Authors: Levreault Eleni , Sheridan Nicole , Masud Fahad , Robinson Amy , Tse Sandy 
Published: October 2022

Abstract

Background
Implicit bias and structural racism in healthcare create significant social and health inequities that can lead to poorer care and health outcomes. Canadian medical training programs have created curricula addressing these issues, but there remains a lack of education targeting faculty members and multidisciplinary teams. Perdomo et al. created a longitudinal case-based curriculum called Health Equity Rounds (HER) to engage faculty and teams in discussions about the effects of implicit bias and racism on patient care. Curriculum pilot results suggested some opportunities to mitigate the potential impact on patient care.

Objectives
This study assessed the feasibility, acceptability, and effectiveness of incorporating HER for multidisciplinary educational rounds in a Pediatric Emergency Medicine (PEM) division. By following previously published curricula, our HER aimed to provide a forum to discuss evidence-based strategies to address implicit bias and structural racism in healthcare.

Design/Methods
Two HER were embedded within PEM Update Rounds over six months and targeted an interdisciplinary audience from all stages of training. Selected cases were provided by the institution’s Equity, Diversity, and Inclusivity steering committee, where 1) patient care and/or outcomes were affected by implicit bias and/or racism, and 2) experiences were appropriate for analysis and education. Participants in this mixed-methods study completed an online survey following HER and were invited to individual interviews that further explored their experience and any resulting professional and personal impacts.

Results
The two topics selected for HER rounds were Implicit Bias in Medicine and Linguistic Barriers to Healthcare, with high post-rounds survey uptake of 80% (20/25) and 65% (14/22), respectively. Among respondents, 73.7% and 78.6% indicated that learned objectives would impact their clinical practice; 80% found both presentations engaging; 80% and 61.6% found educational value of HER to be good/excellent; and 94.7% and 78.6% indicated interest in future HER presentations. Three respondents completed interviews. After thematic analysis, overarching themes included receptiveness to creating more equitable infrastructures in PEM; equity being a shared and multi-disciplinary responsibility; and strategies for implementing HER topics into practice.

Conclusion
There is a need in academic and clinical medicine to address implicit bias and structural racism as contributors to health inequities. Positive feedback from this study suggests HER may be an acceptable and feasible forum to promote safe discussion and reflective practice on potentially provoking topics within interdisciplinary PEM educational sessions.
73 Parenting Experiences of Families of Refugee Background in the Greater Toronto Area: A Formative Study
Authors: Ho Bernice , Kaur Pardeep , Kaukab Tanvir , Rashid Meb , Bowry Ashna , Yousafzai Aisha , Minhas Ripudaman 
Published: October 2022

Abstract

Background
As of date, the world is experiencing its highest levels of human displacement, with many families resettling in Canada. While there is an understanding that families of refugee background have complex, multigenerational mental health, and developmental needs, little is known about whether their parenting needs are met adequately in Canada after resettlement nor how COVID-19 related restrictions have further complicated their resettlement experience.

Objectives
To gather data about the facilitators and barriers that impact the parenting experience of families of refugee background in the Greater Toronto Area (GTA) in the context of their children’s unique developmental and resettlement needs.

Design/Methods
This was a qualitative, community-based participatory research study. All data was collected from August 2019 to July 2020. In-depth interviews (IDIs) were conducted with caregivers of refugee background and healthcare providers that work closely with this population. Data were recorded, transcribed, and coded by two independent coders and a peer-debriefing strategy was used to verify the coding approach.

Results
In total, 20 IDIs were conducted (7 caregivers, 13 care providers). Six key themes were identified: (1) Mental Health and Healthcare Access, (2) Language, (3) Navigating Canadian Systems, (4) Finances, (5) Cultural Dimensions of Caregiving, and (6) Advocacy and Agency. The caregivers and healthcare providers agreed that language is a migration barrier, housing and financial stability are challenging to obtain, and that families struggle to self-advocate. There was disagreement as to how families and healthcare providers viewed healthcare access: caregivers reported that they have good access, but the providers cited that there are still barriers, including health literacy and cultural differences. While caregivers believe they are well supported by the government, healthcare providers believe more funding and education on the families’ rights are necessary. Finally, although most caregivers describe Canada as welcoming, healthcare providers highlighted more incidences of misunderstandings and gaps within the system that may allow families to fall through the cracks.

Conclusion
Our study describes the unique facilitators and barriers to the resettlement, healthcare access, and lived experiences of families of refugee background raising children within the GTA.
79 Impact of COVID-19 wave 3 paediatric inpatient unit closures on transfers to tertiary care paediatric hospital
Authors: Esser Kayla , Badour Bryn , Davis Paul , Langrish Kate , Chan Pamela , Shouldice Michelle , Beck Carolyn , Van Clieaf Judy , Baker Andrew , Orkin Julia 
Published: October 2022

Abstract

Background
During Wave 3 of the COVID-19 pandemic, 15 community hospital paediatric inpatient units (comprising 167 beds) in Toronto were directed to close by the Greater Toronto Area (GTA) Hospital Incident Management System (IMS) Command Centre to increase adult inpatient bed capacity. All paediatric patients from closed inpatient units were redirected to a single tertiary care paediatric hospital, which increased capacity to accommodate these additional patients through activation of surge plans, while community hospitals redeployed resources to fill much needed gaps in adult care.

Objectives
The objective was to describe patient characteristics of all transfers during the closure to explore the impact of community paediatric inpatient unit closures on transfers to the tertiary hospital.

Design/Methods
A chart review of all transferred patients was conducted during the mandated closure and subsequent reopening. Transfers excluded ICU-level transfers as these were not impacted by IMS mandated closures. All transfers were categorized as requiring tertiary care (i.e. would typically be transferred) or not requiring tertiary care (i.e. only transferred due to the closure). Variables collected included sending hospital, admitting diagnosis, patient age, hospital disposition, and length of stay. Data was collected until the last paediatric unit reopened. Quality improvement project approval was granted by the institution.

Results
A total of 858 patients were transferred to the tertiary hospital during the 67 day closure; of those, 530 were transferred solely to increase adult bed capacity (i.e. were categorized as patients requiring non-tertiary care). The majority of patients were admitted to general paediatrics (52%), and 39% went to a surgical inpatient unit. Most patients (68%) admitted had a length of stay between 24 and 72 hours. A third of patients admitted were under 2 years old, and a third were over 12 years old. The top three diagnoses for admission were infections, gastrointestinal issues, and general surgery. Two-thirds (60%) of transfers from closed sites came from three sites.

Conclusion
More than half of the transfers occurred solely due to the mandated closures, and transfers returned to a stable volume once all sites re-opened. The GTA hospital system was able to respond to the mandated closure effectively through clear high-level communication, escalation processes and structures as well as responsive, real-time problem solving. Closures increased potential adult inpatient capacity by 6740 bed days and demonstrated an unprecedented system-wide approach to the provision of integrated paediatric care across the region.
85 Mental health service utilization and cost amongst parents post NICU discharge: A descriptive analysis
Authors: Diamond Laura , Moretti Myla E , Esser Kayla , Cohen Eyal , O'Brien Karel , Ungar Wendy J , Orkin Julia 
Published: October 2022

Abstract

Background
While mental health disorders are common in the postpartum period, the mental health of parents of infants in the neonatal intensive care unit (NICU) may be further compromised. Previous research demonstrates that up to 40% of NICU parents exhibit elevated levels of depression and anxiety, and endorse trauma symptoms shortly after their baby’s birth.

Objectives
To describe the parental and infant characteristics and costs associated with MHS use in parents of infants recently discharged from seven Canadian level III NICUs.

Design/Methods
The study was nested in an ongoing clinical trial of parents of high-risk infants across seven Canadian level III NICUs. Parent and infant characteristics were obtained at enrollment and summarized. Information pertaining to MHS use was obtained from the Resource Use Questionnaire administered to parents at 4 months post-enrollment (RUQ-4m). A pricing table allocating standard costs for services was created to estimate MHS costs for the services reported across the follow-up interval.

Results
A total of n=213 families completed the RUQ-4m. Of these, 33 individual parents (8%; n=25 female, n=8 male) across 28 families (13%) used MHS following infant discharge from the NICU. Therapy, including psychotherapy and social work, was the most utilized service (46%), followed by psychology (24%) and psychiatry (12%). Using the pricing table to estimate costs, an average of $541 per month was spent on MHS per family. Of these costs, 34% were paid directly by a government program, while 31% were paid at least in part out-of-pocket.
Three-quarters (72%) of MHS users were born in Canada compared to 47% of non-users, 72% were on a leave from work compared to 59% of non-users, and 79% were first-time parents compared to 62% of non-users. The average length of hospital admission for infants of MHS users was 100 days compared to 143 days for non-MHS users. Finally, 20% of MHS users reported past or current depression compared to 8% of non-users.

Conclusion
We found that just over one-tenth of families used MHS post-discharge, that those who used MHS primarily used therapy, and that mental health services cost an estimated $540 per family per month. This is the first pan-Canadian study to describe MHS utilization and cost amongst parents post-NICU discharge. Given the high rates of mental health conditions in this population, the rates of MHS use reported were lower than expected. This preliminary data may represent those who were able to access care, rather than all participants who may have required MHS.
87 Big shoes to fill: Realities of Rural Pediatricians in British Columbia
Authors: Ward Valerie , Retallack Jennifer , Miller Kirsten 
Published: October 2022

Abstract

Background
Recruitment and retention of paediatricians remains a challenge in rural settings across Canada. In British Columbia, paediatricians are specialty physicians who provide consultation for children and neonates who are acutely unwell or with complex medical conditions. Little is known about the state of rural paediatrics in British Columbia (BC) and the reality of the province's rural paediatricians.

Objectives
Using a survey, this study aimed to understand rural paediatrics in BC, in terms of physician workload and burnout, recruitment, and participation in medical education.

Design/Methods
For the purposes of this survey, those communities with a rural practice subsidiary agreement (RSA) were considered rural. There are 12 RSA communities with paediatricians in BC, served by 32 paediatricians. Surveys were sent to the 28 paediatricians with available contact information and responses were received from 96% (27/28) of those paediatricians.

Results
Only one community has more than 5 paediatricians, and 11/12 communities are supported by a single or pair of paediatricians. Sixty-three percent of respondents have been in practice for 10 or more years, and all of the solo paediatricians have been in practice for more than 10 years. This data supports previous studies, which have identified aging of paediatricians, fewer new graduates choosing to practice in rural settings, and difficulty retaining those currently practicing as key factors contributing to the challenges in providing rural paediatric care. Over 75% of respondents reported some degree of burnout, and no respondents were looking to increase their workload. The workload challenges did not seem to be affected by the number of paediatricians in a community. Recruitment was a significant concern for over 80% of respondents, and only 7% felt their community had effective recruitment strategies. When asked what recruitment strategies have previously been effective, mentoring by local paediatricians was a frequent response, indicating that physicians are taking it upon themselves to actively recruit others. Approximately 80% of respondents reported participating in the education of medical students or residents, which has been shown to increase job satisfaction when balanced with workload.

Conclusion
This survey will contribute to the understanding of the current state of rural paediatrics in BC, a will form the basis for the development of new initiatives, and allow for their evaluation as they are implemented.
91 The impact of non-pharmaceutical public health interventions on hospital admissions and mortality from common causes of pediatric respiratory distress: a single center perspective
Authors: Parker Madeline , Griffin Olivia , Lévesque Félix , Kurji Ayisha , Woods Erin 
Published: October 2022

Abstract

Background
In response to the COVID-19 pandemic, jurisdictions around the world implemented policies to reduce COVID-19 transmission through public masking, travel restrictions, and closure of non-essential businesses. Collectively known as non-pharmaceutical interventions (NPI), these strategies reliably reduce the spread of COVID-19. International data suggests NPI also reduce hospitalizations for pediatric respiratory infections and their consequences, particularly asthma exacerbation. However, few Canadian studies have examined the impact of NPI on hospitalizations for common causes of pediatric respiratory distress.

Objectives
This study describes the impact of NPI on admissions for bronchiolitis, pneumonia, and asthma at a Canadian pediatric tertiary care centre.

Design/Methods
A retrospective chart review was conducted including all pediatric patients &lt;18 years admitted to the general pediatric and pediatric intensive care units with bronchiolitis, pneumonia, or asthma. Data regarding diagnosis, length of hospitalization, and mortality were collected before (September 2016-March 2020) and in the 6 months after provincial NPI implementation (March 2020-September 2020). NPI were present throughout this period, however, specific measures varied due to evolving public health orders. Chi-squared testing was conducted to describe the impact of NPI on number of admissions, length of hospitalization, and mortality.

Results
Participants (n=1631) included 111 (6.8%) patients &lt;1 month, 878 (53.8%) patients 1-23 months, 331 (20.3%) patients 24 months-4 years, and 311 (19.1%) patients ≥5 years. A mean of 205 patients were admitted every 6 months with respiratory distress (bronchiolitis, pneumonia, and/or asthma) prior to NPI implementation. During this timeframe, the 6-month mean admissions due to asthma, pneumonia, and bronchiolitis were 48, 56, and 101, respectively. In the 6 months following NPI implementation, there were 56 admissions for respiratory distress, including 15 for asthma, 19 for pneumonia, and 22 for bronchiolitis. Mean length of stay increased following the implementation of NPI from 8.49 to 11.68 days, whereas 6-month mean mortality decreased from two to zero deaths. Results did not attain statistical significance (p&gt;0.05).

Conclusion
Results suggest NPI reduce hospitalizations and mortality from bronchiolitis, pneumonia, and asthma. Given the similar seasonality of these conditions, periodic use of NPI beyond the COVID-19 pandemic may reduce pediatric morbidity and mortality from common causes of respiratory distress. However, additional research is needed to describe the relationship between NPI and length of hospitalization. Future studies should also examine the impact of NPI on other pediatric infectious diseases to better characterize their utility.
92 Confirmatory genetic testing for all CF screen positive newborns: a 12-year analysis
Authors: Zhang Steven , Fleischer Erin , Mullowney Tara , Ho Stephanie , Price April 
Published: October 2022

Abstract

Background
Cystic fibrosis (CF) is an autosomal recessive disease that can present with multisystem manifestations based on mutations in the CF transmembrane regulator (CFTR) gene. Screening for CF was added to the Newborn Screening Ontario (NSO) program in 2008 using immunoreactive trypsinogen and genetic testing with a panel of 39 + 3 polymorphisms. From 2008-2020, our centre had all referred screen positive individuals undergo confirmatory genetic testing with an expanded panel of 70 + 4 polymorphisms, occasionally identifying a second mutation of varying clinical consequence. If an individual had a second mutation identified on our panel, prospective follow-up was offered.

Objectives
The aim of the study is to evaluate the utility of our expanded panel and subsequent identification of individuals with possible CFTR dysfunction.

Design/Methods
We conducted a retrospective descriptive analysis of our database of screen positive individuals, focusing on the subset who had a second mutation identified through expanded panel and whom we have offered clinical follow-up for 12 years.

Results
From 2008 to 2020, 718 screen positive individuals were referred to our CF Canada-accredited centre. 566 had one mutation identified by NSO. 94 of these had a second mutation identified on expanded panel. Of these, 13 had a sweat chloride between 30-60 mmol/L and 7 had a positive sweat test. Of those with borderline or negative sweats, 9 individuals continued to be followed. Two have converted to positive sweats, with 1 of these individuals requiring antibiotics for pulmonary exacerbations and the other remaining asymptomatic. Another 2 individuals are trending toward positive sweats (&gt; 50 mmol/L). All spirometry values (FEV1, FVC) have been normal to date, and none have grown Pseudomonas aeruginosa.

Conclusion
Use of a confirmatory expanded panel identified a second mutation in 94 newborns referred with a positive screen. Offering follow-up has allowed us to monitor clinical progression, including conversion to positive sweats in 2 individuals. While spirometry and cultures have been unremarkable, more sensitive measures such as lung clearance index could be considered for future study. As of 2020, NSO moved to the use of extended sequencing and analysis of this change is ongoing.
In vivo study on heparin/poly-l-lysine-copper coating for surface functionalization of ureteral stent
Authors: Awonusi Bukola O , Li Jianzhong , Li Hongwei , Wang Zhenyu , Hu Jiyuan , Yang Ke , Zhao Jing 
Published: October 2022

Abstract
Polyurethane (PU) ureteral stents are used in clinics to maintain the ureteral patency. Due to biofilm formation and encrustation complications, long-term clinical usage has been limited. It is therefore necessary to develop an effective response to this unmet medical need. A heparin/poly-l-lysine/copper (NPs) coating was developed in our previous work that showed the effect of preventing infection and encrustation in vitro. In this work, a further study was conducted by grafting NPs on clinical ureteral stents that then were implanted into the infectious bladders of Wistar rats to investigate the effects of nanoparticles on bacterial growth and crystal deposition in vivo. It was found that decreased numbers of adherent microbes, urease amount splitting by bacteria, and deposited crystals were observed on the NPs stents with significant differences in comparison with PU stents. Besides, histological analysis showed that the NPs stents decreased the host tissue inflammation in close relation to the decrease biofilm formation and encrustation after 28 days of implantation.