bluuebunny/crossref_metadata_2025_split huggingface dataset:
31 Identifying Child Maltreatment in Virtual Medical Appointments - What Are We Missing?
Authors: Lim-Reinders Stephanie , Zwicker Kelley , Ward Michelle , Jain Nita , Kang Kristopher , Malic Claudia , Ornstein Amy 
Published: October 2022

Abstract

Background
Throughout the COVID-19 pandemic, concerns have emerged regarding missed cases of child maltreatment. Evidence suggests an increased incidence of child maltreatment despite a documented decline in reports to child protective services. In Ottawa, reports dropped by 30-40% at the start of the pandemic in 2020. Pediatricians play an important role in the detection of child maltreatment and many have shifted from in person to virtual care. However, there is a paucity of published literature on this topic. We hypothesize that the shift to virtual visits is a barrier to identifying cases of child maltreatment and may contribute to missed cases.

Objectives
Our survey assesses if and how Canadian pediatricians are identifying child maltreatment over virtual medical appointments, as well as the barriers and enabling factors to doing so.

Design/Methods
The Canadian Paediatric Surveillance Program (CPSP) is a joint effort with the Canadian Paediatric Society and Public Health Agency of Canada towards national pediatric surveillance through monthly surveys to 95% of Canadian pediatricians. Using their infrastructure, a one-time survey was sent to 2770 pediatricians between November 2021 and January 2022 with data analyzed for qualitative themes and descriptive statistics.

Results
There was a 34% response rate (n= 928) and 704 valid responses. Exclusions were for no provision of virtual care, incomplete surveys or no reported cases of child maltreatment in their career (n=93, 10%). The average number of years in independent practice was 17.5 years, and 69% had not provided virtual care prior to the pandemic. Based on a virtual visit, at least one case of child maltreatment was reported by 16% of physicians prior to the pandemic, and by 11% following March 2020. Nearly one-third (30%) of these cases required a subsequent in-person visit prior to making the report. Social stressors and clear disclosures from patients and caregivers were the main factors leading to reports. The virtual physical exam was not a factor that triggered concerns of maltreatment in any case. Respondents reported at a rate of 68% that it was slightly or much more difficult to detect child maltreatment over virtual visits. Concerns that a case had been missed or identified late in association with virtual care were reported by 29% of physicians (n=206) with some commenting that clear harm resulted.

Conclusion
This survey shows that virtual medical care presents barriers to identifying child maltreatment and may be an important factor in missed cases of child maltreatment.
32 How do Children with Medical Complexity Die? A Scoping Review
Authors: Ng Grace , Bourassa Marie-Hélène , Patel Hema 
Published: October 2022

Abstract

Background
While children with medical complexity (CMC) are recognized as an emerging and unique cohort, end of life remains poorly understood and little is known about illness trajectory, decision making and communication experiences for this group of patients and their families.

Objectives
This scoping review aimed to describe existing literature on the characteristics of end of life in CMC.

Design/Methods
The study was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Electronic databases (MEDLINE, CINAHL, PsycINFO, Scopus, Embase) were searched up to June 2021. Studies reporting children, adolescents and young adults who were at end of life and fulfilled the definitional framework of medical complexity by Cohen et al were included by two independent reviewers. Data on study aims, design, methods, outcome measures and key findings were extracted, followed by quantitative and qualitative analysis of the results.

Results
Of 1535 publications initially identified, 23 studies were included. In terms of study characteristics, 20 (87.0%) studies were quantitative, 15 (65.2%) were published from 2015 to 2021 and 14 (70.0%) originated from the USA. Study outcomes were categorized into 5 main groups: (1) Place of death (30.8%), (2) Health care use (23.1%), (3) Interventions received or withdrawn (17.9%) (4) Decision making and communication (12.8%) and (5) Others (15.4%). These outcomes were found to be associated with sociodemographic factors and CMC diagnostic categories. Majority of CMC deaths occurred in hospitals and the mean proportion of hospital deaths reported was 68.8% (33.5% to 91.9%). Studies evaluated health care utilization at end of life in various settings including hospice, home care, hospital and the intensive care unit. Interventions studied in this cohort included mechanical ventilation, cardiopulmonary resuscitation, hemodialysis, procedures and medication use. Studies reported that CMC were subjected to more intensive interventions when compared to non-CMC. The 2 main themes which emerged from qualitative studies were that of advance care planning experiences and the unique end of life experiences of CMC and their families.

Conclusion
This scoping review highlighted the unique characteristics of end of life in CMC and outlined the emerging body of literature as well as knowledge gaps on this topic. A better understanding of this cohort of CMC would serve to inform clinical practice, service development and future research opportunities.
36 Feasibility Testing of Online Health Symptom Trackers for Children with Medical Complexity at Home
Authors: Dharmaraj Blossom , Beatty Madison , Adams Sherri , Moore Clara , Miranda Susan , Stinson Jennifer , Desai Arti , Bartlett Leah , Culbert Erin , Cohen Eyal , Orkin Julia 
Published: October 2022

Abstract

Background
Children with medical complexity (CMC) are a highly medicalized population of children due to the complexity of their clinical presentations, various diagnoses, and multiple care providers. Real-time health information can inform clinicians to make better recommendations and improve clinical outcomes. In other populations, such as children with Type 1 diabetes, online health symptom trackers (HST) were used to facilitate clinic visits and track symptoms longitudinally. To-date, HSTs have not yet been examined in a clinical setting with CMC and their families.

Objectives
The aims of our study were to create a standardized online tool, which supports the creation of online HSTs, and to assess their utility in clinical care from a parent and health care provider (HCP) perspective.

Design/Methods
Parents of CMC were invited to use a standardized online care platform called Connecting2gether for 6-months and create online HSTs that could be shared with their HCPs. Online HSTs could be added by parents from a prepopulated list with an open notes section, and the ‘Signs and Symptoms’ trackers could be customized by parents. A demographic survey was completed at baseline. At 6-months a tracker acceptability survey and in-depth semi-structured qualitative interviews were completed to assess the utility and usability of HSTs. HST usage data were also collected. Interviews were analyzed via thematic analysis whereby codes were generated to inform themes, and surveys were analyzed using descriptive methods.

Results
Thirty-six parents enrolled on the platform and 21 (57%) created at least one online HST during the study period. The most used HSTs were ‘Signs and Symptoms’, ‘Sleep’, and ‘How I Feel’. Majority of parents (86%) reported finding the trackers useful. Only 55% of HCPs viewed the HSTs and of those, 36% reporting using them in clinical care. Qualitative interviews revealed three themes: 1) HST Usability: HSTs were used in different settings such as in clinic and school, they were used to guide conversation as a visual over time, and they used in decision making; 2) Enhancement to HST Usage: suggestions included having more options of different symptoms; and 3) Challenges and Barriers to HST Usage: including personal preference and medical stability of the patient.

Conclusion
The ability of online HSTs to visually depict the change in symptoms over time in CMC was found to be a benefit from a parent and HCP perspective. HSTs were identified as a tool used in clinic to guide conversation and decision making, and as a visual to track symptoms longitudinally. However, HCPs need more guidance on how to use trackers. Future directions for online HSTs include integration into the electronic health record to increase accessibility.
38 Developmental Screening Using the Infant Toddler Checklist at 18 Months and School Readiness at 4 to 6 Years
Authors: Nurse Kimberly , Janus Magdalena , Birken Catherine , Keown-Stoneman Charles , Omand Jessica , Maguire Jonathon , Reid-Westoby Caroline , Duku Eric , Lebovic Gerald , Mamdani Muhammad , Simpson Janis Randall , Tremblay Mark , Parkin Patricia , Borkhoff Cory 
Published: October 2022

Abstract

Background
The American Academy of Pediatrics recommends developmental screening at multiple visits using both a general developmental tool and an autism spectrum disorder (ASD)-specific tool. The Canadian Paediatric Society recommends screening at a single visit at 18 months. There is no consensus on which tool is best suited for one-time screening. The Infant Toddler Checklist (ITC) identifies children who are at risk for communication impairment, may detect ASD, and may be a useful screening tool at the 18-month visit.

Objectives
To examine the screening test accuracy of the ITC at the 18-month visit to predict school readiness at kindergarten age.

Design/Methods
This prospective cohort study included children who attended primary care health supervision visits in Toronto, Canada. Parents completed the ITC at the 18-month visit and teachers completed the Early Development Instrument (EDI - a population-level measure of school readiness in kindergarten) at 4-6 years. An ITC screen is positive if there is concern for expressive speech delay (speech composite below the 10th percentile) and/or other communication delay (social composite, symbolic composite or the total score below the 10th percentile). Children were considered overall vulnerable on the EDI if at least one of five domains was below the 10th percentile of the Ontario population: language and cognitive development; physical health and well-being; social competence; emotional maturity; communication skills and general knowledge. We calculated screening test properties with 95% confidence intervals (CIs), using EDI vulnerability as the criterion measure. We used multivariable regression models to examine the association between the ITC and EDI domains.

Results
Of 293 children, 30 (10%) had a positive ITC. At follow-up, 54 (18%) children had a teacher-reported EDI vulnerability. The specificity (range, 87%-96%) and negative predictive value (range, 83%-95%) for the ITC were high; false positive rate was low (range, 4%-13%); sensitivity was low (range, 11%-37%). A positive ITC was associated with a lower score in EDI language and cognitive development (b= -0.62, 95% CI: -1.25, -0.18; P=0.046) and EDI communication skills and general knowledge (b= -1.08, 95% CI: -2.10, -0.17; P=0.036). We found no evidence of an association between ITC and EDI vulnerability.

Conclusion
The ITC at 18 months had high specificity (87%-96%) suggesting that most children with a negative ITC will demonstrate school readiness at 4-6 years. False positive rates were low, minimizing over-diagnosis. The ITC, with its focus on speech and language, communication disorders and ASD, may be a candidate for screening at the 18-month visit.
39 Developmental Pediatrics Canadian Workforce Survey
Authors: McLeod Scott , Marrello Anna , Fehlings Darcy , Eliason Sabrina , Penner Melanie , Mickelson Elizabeth 
Published: October 2022

Abstract

Background
Children with complex developmental needs may require assistance from a developmental pediatric specialist to complete specialized assessments, treatments, and therapies. Despite reports of large waiting lists at many academic centres, there is no workforce information regarding developmental pediatric care in Canada. Prior surveys of the developmental pediatric workforce in the United States have suggested that the pipeline of new trainees completing sub-specialty residency in developmental pediatrics may not be sufficient to meet predicted needs.

Objectives
In an effort to capture demographic data to understand the current developmental pediatric workforce, we conducted a survey to determine: 1) the demographic profile of developmental pediatric professionals who comprise the current workforce and their career plans; 2) the challenges and trends needing to be considered for future resource planning; and 3) opportunities for innovative care provision within developmental pediatrics.

Design/Methods
The workforce subcommittee of the Developmental Pediatrics Specialty Committee of the Royal College of Physicians and Surgeons of Canada (RCPSC) drafted a 26-item questionnaire. This cross-sectional survey was pilot tested, and guided by a previous instrument used by the American Academy of Pediatrics. The study population included practicing developmental pediatricians in Canada, who were sent an email link from the RCPSC inviting them to respond. Data analysis was completed using descriptive statistics.

Results
A total of 145 participants completed the study (91% response rate). Forty-five percent of the responding developmental pediatricians have &gt;20 years of experience. Within the next three to five years, 23% of the respondents plan to retire completely from practice. Trends influencing workforce planning were identified including the influence of government funding resources for specific neurodevelopmental disorders (32% of responses), requirements for translation services (70% of responses), and coordination issues with multi-disciplinary assessments (64% of responses). Top ranked priorities for innovative care provision in this specialty included further collaborations with community mental health agencies, capacity building in Autism Spectrum Disorder diagnosis, and an increased focus on care navigation efficiencies.

Conclusion
There are concerning trends present in the demographic distribution of developmental pediatricians given upcoming retirements and increasing service demands. Targeted advocacy to promote capacity building and recruitment to the specialty may be needed to ensure service needs continue to be met.
44 Prevalence estimates of Cerebral Palsy among 4-year-old children living Manitoba, Births: 2013-2015
Authors: Ricci Maria Florencia , Paterson Marie , Anterola Andreah , Hammond Elizabeth , McCammon James , Lau Jonathan , Day Chelsea , Rafay Mubeen 
Published: October 2022

Abstract

Background
Cerebral palsy (CP) is the most common physical disability in children with an estimated prevalence of 2.1 per 1000 live births. Understanding the provincial prevalence of CP and describing clinical sub-types within Manitoba assists with planning future funding and ensuring adequate resources.

Objectives
This study aimed to determine the prevalence estimate of CP among 4-year-old children in Manitoba, and further describe children’s clinical presentation.

Design/Methods
As the Rehabilitation Centre for Children (RCC) is a referral site for all Manitoba children requiring multidisciplinary evaluation/treatment for CP, this retrospective study used RCC’s electronic medical records to identify all 4-year-old children who had a confirmed CP diagnosis, were living in Manitoba and were born between Jan 2013 to Dec 2015. To ensure provincial data was complete, information was cross-referenced with the Pediatric Neurology Clinic’s medical records and the Neonatal Follow-up database. Prevalence rate was determined using Government of Manitoba denominators of same age children. The Gross Motor Function Classification system (GMFCS) determined the child’s level of functioning

Results
The prevalence of CP in Manitoba (birth years 2013-2015) for 108 4-year-old-children is 2.05 (95% CI1.7, 2.5) per 1000 4-year-old children. Of the 108 4-year-old children with CP, 6 (5.6%) had a post neonatal cause, while 102 (94.4%) had a perinatal cause; and 51/108 (47%) were born preterm. Motor subtypes for 108 children are: Spastic 99 (91.7%) including hemiplegia 41.4%, diplegia 21.2%, triplegia 8.1%, and quadriplegia 29.3%; Dyskinetic 4 (3.7%); Ataxic 3(2.8%) and Hypotonic 2 (1.8%). 58/108 (54%) were independent ambulators (GMFCS level II/II).

Conclusion
Our provincial rate of CP is consistent with the prevalence reported in developed countries. Understanding the clinical presentation assists in informing treatment and resources for children with CP in our province.
45 Using fetal ultrasound to predict developmental outcomes in children born with cardiac defects in Manitoba: A historical cohort study
Authors: Ricci Maria Florencia , Zohair Filza , Day Chelsea , Pylypjuk Christy 
Published: October 2022

Abstract

Background
The cavum septum pellucidum (CSP) is a normal anatomical cavity found in the mid-brain of the fetus and is routinely imaged at the time of mid-pregnancy obstetrical ultrasound as part of anatomic survey. Presence of the CSP reflects intact intrahemispheric connections and an intact corpus callosum. The CSP space then closes by the time of birth or early infancy, however persistence of the CSP into adulthood has been described in those with the schizophrenic phenotype of DiGeorge syndrome. Preliminary work by our group in Manitoba has shown utility in measurement of CSP width to improve non-invasive prenatal diagnosis of DiGeorge syndrome among fetuses with and without conotruncal cardiac defects. However, there exists no information about the relationship between fetal CSP width and future neurodevelopmental outcomes, such as Bayley-III scores, in children with cardiac lesions in the absence of underlying genetic comorbidities.

Objectives
To determine the relationship between cavum septum pellucidum (CSP) width and neurodevelopment in children born with sever cardiac defects.

Design/Methods
This was a historical cohort study of children born with cardiac anomalies in Manitoba (2009-2019). Eligible children with developmental pediatric follow-up between ages 18-24 months corrected age were identified using a clinical repository. Post-processing measurement of fetal CSP at mid-gestation using stored obstetrical ultrasounds was performed by two blinded and independent reviewers in a standardized fashion. Ultrasound reports were also reviewed to collate data about routine fetal biometry and imaging data then linked to demographics, birth information, surgical details and neurodevelopmental outcomes (Bayley-III scales). Linear regression models were used to evaluate the relationship between CSP width and Bayley-III scores; inferential statistics were used to compare outcomes between groups (biventricular versus single-ventricle repair).

Results
78 of 111 eligible cases had stored ultrasound images and included in the analysis. Most children were delivered at term following vaginal delivery (71%), with normal birthweight and Apgars. Median CSP width was 3.8mm (SD 1.2). There was a range conotruncal cardiac anomalies and 47% required single-ventricle repair. There was no obvious relationship between
CSP width and Bayley-III motor (p=0.932) or cognitive domains (p0.686), however there was a trend towards larger CSP and higher Bayley-III language scores (p=0.049).

Conclusion
The influence of the deoxygenated blood on the developing fetal brain in modifying outcomes for children with severe cardiac defects needs future study to improve postnatal development in this high-risk group.
46 Patterns of referrals for evaluation of Autism Spectrum Disorder in the pediatric population of Saskatchewan as a predictor of diagnostic outcome
Authors: Legault Olivier , Neufeld Ruth 
Published: October 2022

Abstract

Background
The Alvin Buckwold Child Development Program (ABCDP) serves Northern and Central Saskatchewan as a tertiary diagnostic centre for Autism Spectrum Disorder (ASD) but data is lacking on referrals and diagnostic outcome.

Objectives
This study aimed to assess if referral patterns are associated with diagnostic outcome of ASD.

Design/Methods
We conducted a retrospective cross-sectional study of patients from the ABCDP who were referred and assessed for ASD, or who received a diagnosis of ASD, from January 1st, 2016 to December 31st, 2018. Predictor variables were the referring clinician type and referral content. Suspicion for ASD from referrals were reported as being concerning for one, both or none of the DSM-5 core criteria for ASD (social communication and interaction “criteria A”; restricted and repetitive behaviors “criteria B”). When available, speech-language pathologist (SLP) reports were reviewed to identify concerns of social communication. The main outcome was a diagnosis or not of ASD. Risk ratio (RR) and odds ratio (OR) were estimated by simple logistic regression models to assess the association between individual variables of referral patterns and diagnosis of ASD.

Results
The final dataset included 527 patients after excluding 128 patients (123 were not seen at our center and 5 had a virtual assessment of ASD). A total of 365 patients received a diagnosis of ASD, 140 did not receive a diagnosis, 21 had their diagnosis deferred and one had this information missing. Referrals by physiotherapist (PT) were 46% more likely than other sources of referrals to lead to a diagnosis of ASD (RR=1,46; 95% CI 1,37-1,54; p=0,022). Referrals by SLP were 25% more likely than other sources of referrals to lead to a diagnosis of ASD (RR=1,25; 95% CI 1,12-1,39; p&lt;0,0001). Referrals identifying concerns of social communication in SLP reports were 29% more likely than other sources of referrals to lead to a diagnosis of ASD (RR=1,29; 95% CI 1,16-1,43; p&lt;0,0001). Using no criteria as reference group, referrals with concerns of criteria A were about 2.7 times more likely to lead to a diagnosis of ASD (OR=2,69; 95% CI 1,427-5,054; p=0,002).

Conclusion
In our study population, we found that certain referring clinician type (SLP, PT) and content of referrals (concerns for social communication in SLP reports, main concerns related to criteria A) are more likely to lead to a diagnosis of ASD. These findings could be used to identify referrals with a higher risk of ASD and allocate resources accordingly.