bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit of Pulse Oximetry Screening for Critical Congenital Heart Disease (Cchd) in Newborns
Authors: Lightfoot M , Hough P , Hudak A , Gordon M , Barker S , Meeder R , Colpitts M , Roberts J , Smith WG 
Published: September 2022

Abstract
BACKGROUND: UK data suggests that 25% of infants with CCHD are not diagnosed with heart disease until after discharge from the nursery (0.6 per 1000). In general SpO2 ≤ to 95% or a difference of upper and lower SpO2 of more than 3% in a newborn greater than 24 hours of age is considered significant. In March 2014 the Maternal Child Newborn Screening Committee of the Provincial Council for Maternal Child Health (PCMCH) recommended screening for critical congenital heart disease in Ontario.
OBJECTIVES: To assess the efficacy and cost related parameters of a new screening protocol for CCHD.
DESIGN/METHODS: An audit of consecutive healthy normal newborn patients over a one-year period was undertaken.
RESULTS: The cost of screening estimated for our center was approximately $7.20 per patient. The median age of screening was 25 hours (6-80 hours). Four patients were screened positive and were seen by a paediatrician in consultation. No Echocardiograms were ordered. No child in this screening survey had CCHD (specificity 99.4%). The screening compliance was 94.7%. One patient from our regional catchment area was delivered at an alternate secondary level center where there is no CCHD protocol in effect. The infant was discharged home and returned to the primary level center two days later in shock. The ultimate diagnosis was Hypoplastic Left Heart Syndrome. The estimated cost of the resuscitation was $1000. The emergency transport (direct) cost for this unstable newborn by helicopter is estimated to be $5000.00.
Conclusion: Cost analysis: The total direct costs of the CCHD screening program for a year is approximately $5200. The costs for the four patients who were falsely identified as having CCHD is estimated at $200. The total direct cost to the system of the one patient in our region who was not screened and was subsequently identified as having CCHD was estimated to be $6000. Assessment issues: In contrast to the US references, none of the false positive cases had an echocardiogram ordered. The cases were dealt with by utilizing a consultation with a paediatrician. Compliance with routine newborn orders: The screening compliance rate of 94.7%.
CONCLUSIONS: A simple screening test for Critical Congenital Heart Disease was successfully undertaken in a secondary level center over a one-year period. The test was cost effective, with high specificity (99.4%) and good compliance (94.7%).
Developing Skills for Developmental Disabilities: Assessing Efficacy in An Innovative Preclinical Elective
Authors: Peters L , Penner S , Kanji R , Andrews D 
Published: September 2022

Abstract
BACKGROUND: Many medical students feel they are not trained with adequate skills and knowledge regarding cognitive and physical disability. Because of this, students may have poor clinical skills in assessing developmental delays and discomfort when interacting with these patients. “Developing Skills for Developmental Disabilities (DSDD)” is a 12-hour preclinical (years 1 and 2) elective developed collaboratively by a group of medical students and developmental pedi-atric faculty. This elective provides training in disability, behaviour, family challenges, and available interventions via faculty presentations, peer teaching, simulation sessions, and observation of a clinical developmental intervention program.
OBJECTIVES: Our objective is to assess the efficacy of this new elective-which aims to assist students in correctly and comfortably identifying pediatric patients with, or at risk for, developmental delays and ininterac-tions withfamily members.
DESIGN/METHODS: Participating students completed a 10-question survey (responses administered on a 5 point Likert scale) at the start and end of the elective, whereby they self-assessed confidence and knowledge when engagingchildren with developmental disabilities. This questionnaire was adapted from confidence surveys used for other curriculum assessments.
RESULTS: 22 preclinical students enrolled in DSDD. Of these, 20 completed the elective and both surveys. Out ofthe 20 participants, 8 (40%) had previous work experience with disability, and 11 (55%) had personal experience (family or friend related). A significant (p0.001, CI 95%) increase in self-reported confidence was seen in 8 of10 survey questions.
CONCLUSION: Overall, DSSD increased preclinical students' self-reported confidence and knowledge regarding pediatric patients with developmental disabilities. Future plans include arepeatsurveycomparing students who opt to take the elective with a control group, randomly selected from the remainder of the class. This willaddress any potential self-selection bias. Because this brief form of intervention was significant in increasing student confidence and skill, aspects of this approach may be adapted into teaching tools for office practice (e.g. assessing development and/ordiscussing care with parents) when medical students are working alongside general pediatricians seeing children with chronic developmental disabilities.
The Generalizability of the Paediatric Developmental Passport: A Multi-Site Randomized Controlled Trial
Authors: Young E , Aiyadurai R , Cellupica U , Jegathesan T , Dillon K , Friedman G , Huber J , Merchant S , Minhas R , Maguire J 
Published: September 2022

Abstract
BACKGROUND: The Pediatric Developmental Passport (passport) is an innovative tracking tool for families of children with autism spectrum disorder (ASD). It provides a mechanism for clearly communicating appropriate regional developmental services, an opportunity track progress in accessing these developmental services and a valuable summary of the developmental care received by that child for pediatrician. A qualitative study with parents and health professionals (developmental pediatricians, developmental nurses, pediatricians) lead to the design and iterative review of the passport.
OBJECTIVES: The objective of this study was to determine the general-izability and effectiveness of the passport compared to placebo in a multi-site pragmatic randomized control trial.
DESIGN/METHODS: A pragmatic multi-site randomized controlled trial was conducted with families of children between 0-6 years of age diagnosed with ASD. Families from two different models of developmental care were enrolled into the study. One site was a sub-urban developmental consultation clinic and the second site was a shared-care model between developmental pediatricians and general pediatricians in an urban resource restricted area. All families included in the study were randomized to receive the passport or placebo (blank card). Agencies providing Autism specific behaviour therapy (ABA) within each site were contacted directly to obtain accurate contact and access status of recommended developmental services. To determine passport effectivenes a pearson’s chi square test was conducted using a significant p value of &lt;0.05.
RESULTS: Forty children with ASD were included and followed in this study. The passport proved to be significantly more effective in aiding families to contact developmental services than the placebo (blank card). A significantly larger portion of families (90.5%) with the passport contacted agencies for ABA (applied behaviour analysis) therapy compared to families with the placebo (61.9%, (p value significant at &lt;0.05). More families with the passport tended to contact ABA in less than 2 months (48%) than the placebo group (35%), but this was not statistically significant.
CONCLUSION: The pediatric developmental passport enables families of children newly diagnosed with Autism to contact necessary behavioural services more often than those who did not receive the passport after diagnosis.
Learning Problems Among Children of Refugee Background: A Systematic Scoping Review
Authors: Graham H , Minhas R 
Published: September 2022

Abstract
BACKGROUND: Learning problems are common, affecting up to one in ten children, occurring within the dynamic, multidimensional context of family, school, community and broader sociocultural environment. Refugee children have, by definition, experienced forced migration, and multiple transitions, and ongoing socioeconomic and cultural challenges that may have cumulative risk factors for learning problems and educational disadvantage.
OBJECTIVES: To review the prevalence and major determinants of learning problems in resettled refugee children and available evidence on their educational outcomes.
DESIGN/METHODS: A scoping review using Arksey and O'Malley’s framework for scoping studies was employed (a systematic search, selection, extraction, analysis and reporting strategy) to identify the prevalence, major determinants of learning problems and educational achievement in resettled refuge children. Relevant studies were identified from searches of MEDLINE, EMBASE, PubMed, CINAHL PsycInfo, and ERIC. Inclusion criteria were peer-reviewed articles in English addressing the prevalence and/or determinants of learning problems in refugee children. Two independent authors conducted abstract and full text article review. The data was extracted systematically and analysed using Arksey and O'Malley’s descriptive analytical method for scoping studies.
RESULTS: A total of 2002 studies were identified and 28 studies met the inclusion criteria to be included in the review. No information was available on the prevalence of specific learning issues, language disorders, or autism spectrum disorders. Included studies found refugee children to possess significant ‘resource’ factors that promote learning success and had similar academic outcomes compared to their native-born peers. Prevalence data were limited, with single studies informing most of the reported estimates. Eight studies examined the impact of trauma on learning identifying mental health issues, personal risk behaviours and lower school performance as key risk factors. Key resource factors were strong family ties, absence of racial discrimination, and school safety.
CONCLUSION: This review provides prevalence estimates for learning problems in refugee children, and highlights key ‘risk’ and ‘resource’ factors. This review provides paediatricians recommendations on how best to identify learning strengths and challenges in refugee children, to better advocate for support in achieving academic success. This review advocates for a larger experimental based research measuring educational outcomes in refugee children. Further research is needed to better define the prevalence of learning problems among children of refugee background and to map out the learning progress longitudinally.
Paediatric Visits to Community Emergency Departments: Outcomes from Referrals and Unscheduled Return Visits to a Paediatric Centre
Authors: Reiner E , Grafstein E , Doan Q 
Published: September 2022

Abstract
BACKGROUND: Approximately 85% of children in Canada who seek emergency care do so in a general emergency department (ED), yet also have access to a dedicated pediatric ED (PED) within reasonable range. Existing pediatric literature describing return visits to the ED for the same medical complaint – an important quality indicator of ED performance – has yet to report on patient flow patterns from general EDs to a PED.
OBJECTIVES: We sought to measure the proportion of children seen at general EDs who subsequently present to a PED for further care. We also sought to elucidate the reasons behind this pattern of revisits, and to describe the clinical management provided at the subsequent visit.
DESIGN/METHODS: A retrospective cohort study was conducted combining linked administrative databases and health records review. We reviewed all pediatric visits (&lt;17 years of age) at 5 general EDs in Vancouver, linking visits between general EDs and the PED based on clincally compatible presentations. Our primary outcome measure was the proportion of general ED visits with a subsequent visit to a PED (within 7 days) during the 2012-13 fiscal year. Secondary outcomes included reasons for PED consultation, the clinical services accessed, and disposition at the PED.
RESULTS: During the study period, 582/17,824 (3.3%) children seen at GEDs subsequently presented to the PED within 7 days. The top 3 diagnoses among these were: fracture, viral infection, and musculoskeletal complaints. Of the 582 children with a visit to the PED, 167 (28.7%) were referred to the PED for a consultation, while the rest were family-initiated. Referred visits were more frequently associated with pediatric subspecialist consultation than family-initiated visits (41.3% versus 21.7%, p&lt;0.01). The referred group more frequently resulted in a surgical procedure (12.0% versus 3.6%, p&lt;0.01) or hospital admission (48.5% versus 11.6%, p&lt;0.01).
CONCLUSION: Knowing the proportion, management, and outcomes of children that are treated in a general ED and subsequently at a PED may provide an important quality measure and opportunities to improve the management of common pediatric emergencies in the community.
The Fan Study: Intranasal Fentanyl and Inhaled Nitrous Oxide for Fracture Reduction
Authors: Hoeffe J , Trottier ED , Bailey B , Shellshear D , Lagacé M , Sutter C , Grimard G , Cook R , Babl FE 
Published: September 2022

Abstract
BACKGROUND: Recently, intranasal (IN) fentanyl and inhaled nitrous oxide/oxygen (N2O) mixture have been increasingly used for procedural sedation and analgesia (PSA) alone or in combination. There is a lack of data on the efficacy of these combined agents.
OBJECTIVES: To evaluate the efficacy of IN fentanyl and N2O as PSA for the reduction of mildly-to-moderately displaced fractures and dislocations.
DESIGN/METHODS: We performed a prospective, observational cohort study between September 2014 and October 2015. Patients were recruited at CHU Sainte Justine (Montréal, Canada) and Royal Children Hospital (Melbourne, Australia). Patients between the age of 4 and 18 years were eligible if PSA consisted of IN fentanyl and N2O for the reduction of mildly-to-moderately displaced fractures or dislocations. Patients received at least IN fentanyl 1.5 mcg/kg (100 mcg max) and at least a 50/50% mixture of N2O with oxygen. Primary outcome was the efficacy of PSA measured by the patient assigned Facial Pain Scale-Revised (FPS-R). The Face, Legs, Activity, Cry, Consolability (FLACC) scale was also recorded. Depth of sedation was evalu-ated using the University of Michigan Sedation Scale (UMSS). Adverse events were recorded following the criteria of the Consensus Panel on Sedation Research of PERC/PECARN. Additional data concerning satisfaction or discomfort were evaluated via questionnaires, and follow-up telephone calls were made to elicit information on adverse events after discharge.
RESULTS: A total of 91 patients aged 9.7±3.0 years were enrolled. There was no difference between the median FPS-R score during the procedure compared to before: Median 2 and 2 (median difference 0 [95% CI 0, 0]), respectively. The FLACC score was higher during the procedure than before: Median 4 and 0 (median difference 2 [95% CI 1, 3]). UMSS was 1 (95% CI 1, 2) during the procedure. 42 (46%) patients had adverse events, all mild: vertigo (20%), nausea (16%)]or vomiting (12%). A total of 85/88 (97%) parents and 82/85 (96%) ED physicians would want the same sedation in another procedure.
CONCLUSION: PSA with IN fentanyl and N2O seems effective in our cohort study, as evaluated by patient assigned FPS-R. Patients were minimally sedated. Adverse events were frequent but mild. Overall, parents and medical staff would want the same agents used in another procedure. Thus, PSA with IN fentanyl and N2O appears to be an attractive option for reduction of mildly displaced fractures or dislocations.
PrÉvalence Et DÉterminants De La Non-Vaccination Contre L’hÉpatite B Chez Les Adolescents Au Canada, 2013
Authors: Caron-Poulin L , Gilbert N , Wilson S , Gilmour H 
Published: September 2022

Abstract
HISTORIQUE: Le Comité consultatif national de l’immunisation (CCNI) recommande depuis 1993 la mise en place de programmes de vaccination universelle contre l’hépatite B au Canada. Depuis 1998, des programmes de vaccination universelle contre l’hépatite B sont place partout au pays. Les calendriers de vaccination systématique ne sont toutefois pas harmonisés.
OBJECTIFS: Mesurer la couverture vaccinale pour l’hépatite B rapportés et identifier les facteurs de risques associés à la non-vaccination.
MATÉRIALS/MÉTHODE: Nous avons analysé les données de 6805 adolescents de 17 ans inclus dans l’enquête nationale sur la couverture vaccinale des enfants (ENCVE) de 2013 pour identifier les facteurs socio-démographiques associés à la non-vaccination, c’est-à-dire n’avoir reçu aucune dose du vaccin contre l’hépatite B. Les variables indépendantes incluses dans l’analyse étaient les provinces et territoires, le fait que les adolescents ou les parents soient nés à l’extérieur du Canada ou non, le statut matrimonial des parents et le niveau d’éducation de ces derniers en plus du revenu familial moyen. Les rapports de cotes ont été calculés au moyen de regressions logistiques simples et multiples. Les intervalles de confiance ont été estimés par la méthode bootstrap.
RÉSULTATS: En tout, 87.9% des adolescents avaient reçu au moins une dose du vaccin. Il n’y avait pas d’association significative entre le statut socioéconomique et le statut vaccinal des enfants pour l’hépatite B. Il existe cependant des différences au niveau de couverture vaccinale pour ce vaccin entre les différentes provinces et territoires du Canada. De plus, à 17 ans le fait d’être né à l’extérieur du Canada était associé à un risque plus élevé d’être non-vacciné comparativement aux enfants nés au Canada, et ce à la limite du seuil de signification (p=0.556).
CONCLUSION: Il existe des différences entre les taux de couvertures des provinces et territoires malgré des programmes de vaccination systéma-tique contre l’hépatite B dans toutes les juridictions. Par contre, il ne semble pas y avoir d’inégalité socioéconomique en lien avec le statut vac-cinal de l’hépatite B des adolescents. Ceci est un fait encourageant pour les programmes de promotion en place dans le pays.
Comparison of First- and Second-Season Palivizumab Prophylaxis in Patients with Chronic Lung Disease (CLD) in the ‘Caress’ Database (2005-2014)
Authors: Paes B , Wang D , Li A , Mitchell I , Lanctot K 
Published: September 2022

Abstract
BACKGROUND: Respiratory syncytial virus (RSV) related hospitaliza-tion (RSVH) rates are 10-fold higher in infants with CLD compared with healthy term infants until 24 months of age. Current pediatric advisory guidelines recommend RSV prophylaxis for CLD infants &lt; 2 years of age based on oxygen requirement for at least 28 days after birth during the first RSV season and those who continue to require chronic medical therapy for the management of CLD during the second season.
OBJECTIVES: This study compared RSVH rates in CLD infants who received palivizumab during the first RSV season (FS) versus the second season (SS) in the Canadian Registry of Palivizumab (CARESS) database.
DESIGN/METHODS: CARESS is a prospective registry of infants who received palivizumab at one of 32 sites across Canada during the 2005-2014 RSV seasons. Demographic data were collected at enrollment and respiratory-illness related hospitalization events were recorded monthly. Infants aged &lt; 24 months with CLD were enrolled.
RESULTS: 797 (55%) and 647 (45%) of 1444 CLD infants were prophy-laxed during FS and SS respectively (average age: 6.9 [FS] versus 13.6 [SS] months). SS infants had a lower gestational age [29.7 versus 31.3 weeks, F(1, 1440) = 29.9, p=&lt;0.0005] and birth weight [1447 versus 1762 grams, F(1, 1436) = 29.3, p=&lt;0.0005]. Infants prophylaxed in the SS also experienced more complicated neonatal courses with: prolonged respiratory support [63.4 versus 50.0 days, F(1, 1089) = 16.9, p=&lt;0.0005], oxygen therapy [135.7 versus 74.8 days, F(1, 1155) = 97.4, p=&lt;0.0005], and longer hospital stays [102.0 versus 72.0 days, F(1, 1369) = 62.1, p=&lt;0.0005]. RSVH rates were 2.23% (FS) and 2.66% (SS). Cox regression adjusted for daycare attendance, multiple births, gestational age, birth weight and neonatal complications found no significant differences in the time to first RSVH between FS and SS infants (Hazard ratio: 0.96, 95% CI 0.37–2.52, p=0.94).
CONCLUSION: SS infants who received RSV prophylaxis for CLD had a similar hazard of RSVH to those who only received palivizumab in the first year of life. The findings imply that FS and SS infants are correctly selected for RSV prophylaxis based on the stipulated criteria and their severity of illness and that SS infants are equally at risk for RSVH compared to FS infants.
Comparing First- and Second-Season Palivizumab Prophylaxis in Patients with Hemodynamically Significant Congenital Heart Disease (HSCHD) in the ‘Caress’ Database (2005-2014)
Authors: Paes B , Li A , Mitchell I , Lanctot K 
Published: September 2022

Abstract
BACKGROUND: Compared with normal children, RSV-related hospi-talization (RSVH) rates in children with HSCHD are 2-4 fold higher even up to 2 years of age with an overall weighted mean mortality rate of 5.2%. Pediatric advisory guidelines recommend prophylaxis against respiratory syncytial virus (RSV) for infants with HSCHD. However, current recommendations cast doubt as to whether prophylaxis is beneficial beyond 1 year of age.
OBJECTIVES: To determine whether there are differences in RSVH in HSCHD infants receiving palivizumab during the first versus second RSV season in the Canadian Registry of palivizumab (CARESS).
DESIGN/METHODS: CARESS is a prospective registry of infants who received ≥1 dose of palivizumab at one of 32 sites across Canada during the 2005-2014 RSV seasons. Demographic data were collected at enrollment and respiratory-illness-related hospitalization events recorded monthly. In the event of a hospitalization, the relevant hospital records were reviewed by the site’s research nurse for detailed information on criteria for hospital-ization, length of stay (regular ward vs. ICU), days on respiratory support and/or intubation, and RSV test type and diagnosis. Infants aged &lt;24 months with cyanotic or acyanotic HSCHD were recruited.
RESULTS: 1306 (64.9%) of 2013 infants received prophylaxis only for the first season. 707 (35.1%) were prophylaxed during the second season (average age in months: 4.7 [first season] vs 14.7 [second season]). Baseline demographics for both seasons were similar. However, infants aged &gt;1year had a more complicated neonatal course, with significantly longer neonatal length of stay (46.7 versus 25.6 days). Infants received: 4.5±1.4 injections; 90.5% of their expected injections and 88.2% of their injections within the appropriate time intervals. 26 infants in the first year (RSVH rate: 2.26%) and 11 infants in the second year (RSVH rate: 2.09%) were hospitalized. Cox regression analysis showed no significant differences in hazards between infants in their first or second year of prophylaxis in the time to first RSVH (Hazard ratio: 1.4, 95%CI 0.5-4.0, p=0.52)
CONCLUSION: Infants enrolled in the CARESS database in the second RSV season had a similar hazard of RSVH as those in the first year of life. These findings suggest that infants aged &gt;1 year with HSCHD who remain unstable, are equally at risk for RSVH and merit palivizumab prophylaxis.