bluuebunny/crossref_metadata_2025_split huggingface dataset:
ÉVALUATION DE LA SÉCURITÉ DE L’IMPLANTATION D’UN PROTOCOLE DE PRISE EN CHARGE DE LA FIÈVRE SANS FOYER D’INFECTION BACTÉRIENNE SÉVÈRE CHEZ LES ENFANTS DE 3 À 36 MOIS À L’URGENCE
Authors: Brodeur G , Guimont C , Turgeon R , Caron J , Blouin L 
Published: September 2022

Abstract
HISTORIQUE: En pédiatrie, la fièvre est l’une des raisons de consultation les plus fréquemment rencontrée. Au Centre mère-enfant du CHU de Québec, un protocole est en place pour orienter la prise en charge des enfants de 0 à 36 mois avec fièvre sans foyer. Avant février 2012, le proto-cole impliquait d’administrer un antibiotique chez tous les patients avec critères laboratoire d’infection bactérienne. Par contre, l’incidence des bactériémies occultes et des infections bactériennes sévères ayant significa-tivement diminué depuis la vaccination extensive contre le pneumocoque, un nouveau protocole a été mis en place afin de diminuer le traitement antibiotique des patients avec fièvre sans foyer.
OBJECTIFS: Objectif principal : Parmi les enfants ayant des critères d’antibiothérapie empirique selon l’ancien protocole, comparer le nom-bre de patients ayant eu une modification de traitement (début ou modification d’une antibiothérapie intraveineuse) avant et après l’implantation du nouveau protocole.Objectif secondaire : Chez les enfants ayant une infection bactérienne sévère diagnostiquée lors du suivi, déterminer si l’évolution est similaire chez ceux ayant reçu ou non une antibiothérapie empirique.
MATÉRIELS ET MÉTHODE: Il s’agit d’une étude rétrospective de non-infériorité. Tous les enfants de 3 à 36 mois qui se sont présentés à l’urgence et qui ont été référés en médecine de jour avec un diagnostic de fièvre sans foyer ont été recrutés. Les résultats de l’investigation initiale, le diagnostic final, le nombre de visites en médecine de jour, la durée d’hospitalisation, l’initiation d’une antibiothérapie et la présence de complications graves ont été répertoriés afin de comparer les 2 groupes.
RÉSULTATS: Sur les 282 patients étudiés, 1 enfant dans le groupe pré-implantation et 2 enfants dans le groupe post-implantation ont eu une modification de traitement en cours de suivi (1 infection urinaire avec germe résistant dans le groupe pré-implantation et 2 bactériémies dans le groupe post-implantation). Aucun patient étudié n’a eu une évolution défavorable (choc, sepsis sévère, défaillance multiviscérale, décès) et aucune différence statistiquement significative n’a été observée dans le nombre d’échec au traitement, le taux d’hospitalisation et le nombre de visites en médecine de jour entre les 2 groupes.
CONCLUSION: Avec cette étude, nous avons démontré qu’il est sécuri-taire de ne pas administrer d’emblée un antibiotique à large spectre chez les enfants de 3 à 36 mois avec bon état général se présentant à l’urgence avec fièvre sans foyer.
Adherence to Diabetic Ketoacidosis Management Protocol: A Paediatric Centre Experience
Authors: Bourdages M , Barbe J , Cloutier D , Bouchard I , Gagné J 
Published: September 2022

Abstract
BACKGROUND: Paediatric diabetic ketoacidosis (DKA) management should be regulated by specific protocols. Following the most recent medical literature, our tertiary pediatric hospital was provided with such a DKA protocol in 2009.
OBJECTIVES: Assess the proportion of cases of DKA that are marked by non-adherence to our DKA management protocol (DKAp). Describe the proportion of patients developing hyperchloraemic acidosis (HCl) during acute treatment of DKA.
DESIGN/METHODS: We conducted a retrospective study by chart review. Deviations to DKAp were classified as minor or major according to their potential impact on patient security. Non-adherence to protocol was defined as the occurrence of ≥ 1 major deviation or ≥ 2 minor deviations.
RESULTS: Seventy-nine patients were included with a mean age of 9,7 years (±4,9). Forty-two (53,2%) were females. Majority of cases were new-onset diabetes (60/79, 75,9%). Within the known diabetic patients (19), the DKA precipitating factor was poor treatment compliance in 10 (52,6%), and insulin pump dysfunction in 4 (21%). Mild DKA (pH 7,21 – 7,30) occurred in 24 (30,4%) patients, moderate DKA (pH 7,11- 7,20) in 30 (38,0%) and severe DKA (pH ≤ 7,10) in 25 (31,6%). Continuous insulin drip was used in 73/79 (92,4%) cases. We observed ≥ 1 major deviation to DKAp in 37/73 (50,7%) cases, mostly failure to monitor hourly neurological status (32/69, 46,4%, 4 missing values) and inappropriate administration of 0,9% NaCl IV bolus in well-hydrated patients (5/73, 7%). Minor deviations (≥2) occurred in 66/73 (90,4%) patients; mostly failure to monitor urine ketones levels every 4 hours (66/73, 90,4%) and blood gas and serum electrolytes every 2 hours (33/73, 45,2%). Overall, non-adherence to protocol occurred in 69 (94,5%) cases. The following complications were observed: 7/73 (9.6%) hypoglycaemia and 1/73 (1.4%) CT scan suspected cerebral edema. No death occurred. Fifty-five patients over 73 (75,3%) experienced HCl, The mean time apparition of HCl was 4:41 hours from the insulin perfusion beginning, using a normal anion gap definition ≤14. The HCl occurrence was associated with a longer insulin perfusion length (with HCl: 17.1±9.1 hours; without HCl: 9.2±5.6 hours, p&lt;0.002).
CONCLUSION: Non-adherence to our DKAp was observed in majority of cases. The establishment of a protocol does not guarantee its adherence and surveillance of its application is needed. More studies have to be done to understand the clinical impact of HCl and to suggest an appropriate IV fluid management.
Clinical and Serologic Patterns in a Large Canadian Paediatric Cohort with Celiac Disease, At Presentation and Follow-Up
Authors: Gould M , Dowhaniuk J , Arredondo J , Cheng J , Azzopardi P , Hu T , Mileski H , Carpenter A , Pai N , Brill H 
Published: September 2022

Abstract
BACKGROUND: Celiac Disease (CD) is a chronic illness involving an autoimmune response to gluten, leading to small intestinal inflammation in genetically susceptible individuals. A weakness in the North American pediatric CD literature exists around serologic outcomes after initiation of a gluten free diet (GFD). Only one published North American pediatric study looks at normalization of TTG after initiation of a GFD and only assessed TTG normalization at 6 months post diagnosis. Data is also limited on other clinical patters such as levels of anemia and BMI over the course of treatment of CD.
OBJECTIVES: We sought to characterize serologic and clinical patterns in CD over an extended course using one of the largest databases of pediatric CD in North America.
DESIGN/METHODS: A retrospective review of all patients diagnosed with CD at our institution from 1996-2014 was completed. Patients required biopsy-proven CD according to the Marsh criteria. Data abstracted included age at diagnosis, gender, reason for referral, comorbidities, family history of CD and autoimmune conditions, BMI, hemoglobin, MVC, fer-ritin, IgA and anti-TTG levels. A Cochran-Armitage trend test was used to trend anti-TTG and hemoglobin normalization over time
RESULTS: 227 patients were identified who met study criteria. Visits with associated anti-TTG or hemoglobin analysis were categorized by time since diagnosis. At 6-12 months, 12-17 months, 18-23 months, 24-29 months, 30-35 months and 36-41 months from diagnosis 66.7% (n=144), 75% (n=40), 85.6% (n= 76), 86.9 (n= 23), 93.5 (n=62) and 95% (n= 20) of patients had normalized their anti-TTG levels respectively from a baseline of 100% abnormal TTG and 5.7% (n=140), 7.3% (n=41), 5.1% (n=77), 5.0% (n=20), 1.6% (n=60) and 5.0% (n=20) had anemia versus 18% at presentation.
CONCLUSION: The small p-value (p=&lt;0.0001) for the Cochran-Armitage test for anti-TTG normalization indicates the increased probability of a normalized anti-TTG as time from diagnosis increases. Knowledge of the slope of this trend could assist clinicians with better understanding the effectiveness of treatment for their patients. In this cohort, anti-TTG levels normalized over a broad time span, with increasing numbers of patients normalizing their anti-TTG through to the end of the study period. Further research goals aim to determine predictors of early anti-TTG normalization. In this cohort, the proportion of patient with anemia quickly decreased from a baseline of 18%, to general pediatric population levels between 6-12 months after treatment initiation and remained stable in this range through to the end of the study period with a non-significant p value (p=0.06) for trend over time.
Obesity and Ethnicity: Obstructive Sleep Apnea Risk Factors Poorly Represented in Sleep Apnea Screening Questionnaires
Authors: Chaudhry A , Nguyen L , Constantin E 
Published: September 2022

Abstract
BACKGROUND: The gold standard for the diagnosis of pediatric obstructive sleep apnea (OSA) is polysomnography, a resource-intensive tool that is not easily accessible. It has been shown thatquestionnaires cannot accurately diagnose OSA in children. However,questionnaires are often used as screening tools for OSA to help clinicians prioritize objective sleep testing in sleep laboratories. Although many tools exist to screen for OSA, there is significant variability in the elements they take into consideration.
OBJECTIVES: To identify all questionnaires that screen for OSA in children and to review and contrast items within these questionnaires.
DESIGN/METHODS: We conducted a review of the literature to identify all questionnaires for pediatric OSA. We searched PubMed (keywords: sleep disordered breathing, OSA, sleep apnea and risk factor) and the health and psychosocial instruments (HaPi) database. We also checked reference lists of all included articles. Questionnaires were included in the analysis if their primary goal was to identify or screen for pediatric OSA in children 0-18 years old. We described the questionnaires qualitatively by identifying all items within each questionnaire, including demographics, risk factors, signs, symptoms, and outcomes.
RESULTS: The search yielded 476 articles. After reviewing titles and abstracts, 130 articles were included of which 60 articles were deemed relevant for final analysis based on predetermined inclusion criteria. Forty-two questionnaires were identified. Thirty-two questionnaires containing 48 different items were included in the analysis. Items most commonly included in questionnaires were: snoring (78%), observed apnea (78%) and daytime sleepiness (75%). Other clinically relevant items, such as ethnicity (6%), and body mass index (31%), were not consistently included. Thirty-one questionnaires used quantitative scores to identify OSA. One questionnaire derived a formula to identify OSA, in which certain items (risk factors) were assigned relative weights. Moreover, most questionnaires sought to predict the diagnosis of OSA without emphasis on OSA severity.
CONCLUSION: There are currently several questionnaires that aim to screen children for OSA. However, these questionnaires rarely include known OSA risk factors such as ethnicityand obesityand are not able to screen for OSA severity.
Child and Adolescent Online Mental Health Information: Parent and Adolescent Perspectives to Inform Development of Canadian Mental Health E-Resources for Paediatrics
Authors: Jovanovic M , Monga S , Korczak D , Grewal S 
Published: September 2022

Abstract
BACKGROUND: Parents and adolescents are searching online for information about mental health. Google searches are frequently used, but do not always yield accurate and reliable information that is presented in a user-friendly manner. The first step toward the development of a useful online child mental health resource is to examine existing web content and understand parent and adolescent needs from online mental health material.
OBJECTIVES: The objectives of this study are two-fold (i) To conduct an environmental scan of existing online repositories of child and adolescent mental health information with respect to both parent and adolescent friendly content on three identified topic areas for the initial phase of the project (Anxiety, Eating Disorders, Suicide Prevention) (ii) To determine parent and adolescent needs from, and perspectives about, current web-based information with respect to site design, content and limitations to inform the creation of a pediatric hospital based web site with a broad range of information pertaining to child and adolescent mental health.
DESIGN/METHODS: An environmental scan was conducted to assess available online information about three identified topic areas as described above. As the project continues, the scan will be expanded to include other topic areas in child and adolescent mental health. Parallel parent needs assessment surveys were conducted. As our adolescent section was being developed, adolescents were surveyed for their feedback regarding illustrations and presentation of current content.
RESULTS: The environmental scan identified 17 hospital websites for in-depth review. Although some websites had information on diverse mental health topics, few contained comprehensive information on a broad range of topics. For example, only 9 had information about anxiety disorders. Additionally, an overall lack of adolescent specific content was noted. Parent surveys revealed significant interest in a strong stand-alone site where they could access mental health information. Parents also indicated that they would prefer separate parent and teen content areas.
CONCLUSION: Current websites providing information regarding child and adolescent mental health, while plentiful, lack sufficient scope, adolescent-friendly content, and interactivity that limit their utility for parents and families. Development of a high-quality and accessible child and adolescent mental health website requires an interdisciplinary collaboration of experts in mental health, website design, and knowledge dissemination. This study has informed the development of a new online resource, interactive elements of which will be shared as part of the oral presentation.
Validation of Hearts-Map, A Psychosocial Assessment Tool Applied to Children and Youth with Mental Health-Related Paediatric Emergency Visits
Authors: Lee A , Deevska M , Stillwell K , Black T , Meckler G , Eslami A , Park D , Doan Q 
Published: September 2022

Abstract
BACKGROUND: Mental health-related pediatric emergency department (PED) visits are increasing annually, and there is a need for a validated comprehensive standardized assessment tool to better manage these patients.
OBJECTIVES: The primary objective of this study was to evaluate HEARTSS-MAP, a psychosocial assessment tool, in terms of inter-rater agreement among clinicians as well as the tool’s performance in predicting needs for acute psychiatric consultation for hospitalization.
DESIGN/METHODS: The HEARTSS-MAP evaluation was done in two phases. We retrospectively reviewed 101 cases randomly sampled from a cohort of patients who sought care at the BC Children’s Hospital (BCCH) PED for mental health complaints. Narratives pertaining to each patient’s psychosocial assessment were recorded. Clinicians, including two emergency physicians, a bedside nurse, a nurse practitioner, and two psychiatrists, were blinded to the patients' outcomes, and individually applied the HEARTSS-MAP tool to the clinical narratives. The inter-rater agreement was calculated using Cohen’s kappa statistics. We then evaluated the tool’s sensitivity and specificity in predicting admission for the retrospective cohort, as well as a prospective cohort of 62 patients assessed and managed by a PED clinician using the HEARTSS-MAP.
RESULTS: There was substantial agreement between the two pediatric emergency reviewers (κ=0.7), and moderate agreement between the pedi-atric emergency physicians and the nurse practitioner (κ=0.6), and the bedside nurse (κ=0.5). Pediatric psychiatrists had fair agreement between themselves (κ=0.3), and between psychiatrists and emergency physicians (κ=0.4). Based on retrospective data, HEARTSS-MAP had a sensitivity of 91% (95%CI: 71 to 99%), and a specificity of 41% (95%CI: 30 to 53%). When applied to prospectively collected data, the sensitivity was 100% (95%CI: 75 to 100%), and specificity was 33% (95%CI: 20 to 48%).
CONCLUSION: HEARTSS-MAP, the first standardized psychosocial assessment tool to be implemented at BCCH PED, demonstrates strong inter-rater reliability between emergency clinicians, with a high sensitivity in identifying patients with mental health complaints requiring hospital admission.
Biochemical Derangements in Patients with Hypoxic Ischemic Encephalopathy Treated With Therapeutic Hypothermia
Authors: Hagel J , Tomlinson C 
Published: September 2022

Abstract
BACKGROUND: Therapeutic hypothermia is the standard of care for treating moderate or severe hypoxic ischemic encephalopathy (HIE) due to birth asphyxia. During the cooling period, altered intermediary metabolism coupled with multi-organ injury due to the underlying hypoxia may result in significant metabolic and biochemical derangements. Since the introduction of therapeutic hypothermia we have noticed an apparent increase in hyperglycemia and hyponatremia though such has not been formally documented.
OBJECTIVES: This study sought to determine if there is a difference in the incidence of biochemical derangements in patients undergoing therapeutic hypothermia for moderate to severe HIE compared to a historical control group receiving standard supportive care.
DESIGN/METHODS: A retrospective chart review was performed with a cluster sampling technique to select all patients ≥35 weeks PMA with a primary admission diagnosis of HIE in the years 2006, 2009, and 2012 at a single institution. This covered a time period before therapeutic hypothermia was established as standard of care, when it was in its implementation phase, and once fully established. Other than the hypothermia itself, there were no major changes in management of these patients, particularly, no change in fluid management regimens. Gestational age, birth weight, APGARs, severity of HIE, medications, blood glucose, electrolytes, liver and renal function were collected retrospectively at all time points during the 72 hour cooling window. Analysis was performed using unpaired students ttest using 0.05 as a definition of statistical significance.
RESULTS: 155 patients were identified, 20 were excluded due to gestational age or suspected/confirmed underlying genetic disorder leaving n=60 cooled neonates and n=75 uncooled. The average gestational age in the cooled group was 39 and 3/7 weeks and in the uncooled group it was 38 and 5/7 weeks. In both groups, there were slightly more males than females with 57% (n=34) in the cooled group and 59% (n=44) in the uncooled group. There is a statistically significant increase in plasma glucose in the cooled group on day one (7.37±1.73 vs. 5.49±1.89, P&lt;0.01) and day two (6.26±1.61 vs 5.34±1.79, P &lt;0.05). There was no difference on day three. Serum sodium was lower in the cooled group on all three days, though it was only statistically significant on day 1 (130.29±4.84 vs. 132.27±4.58, P&lt;0.05). CONCLUSION: Our results suggest that without significant changes in fluid management, therapeutic hypothermia is associated with an increased incidence of hyperglycemia and hyponatremia. Further work is needed to determine if these derangements significantly affect short or long-term outcomes.
Prolonged Nasoenteral Tube Feeding in Children Contradicts Best Practice Guidelines
Authors: Turner J , Abobo M , Blatz D , Hartfield D , Mager D 
Published: September 2022

Abstract
BACKGROUND: Expert consensus guidelines from the Canadian Pediatric Society and the American Academy of Pediatrics state that naso-enteral tube feeding is not appropriate for long term home nutrition support. Therefore, gastrostomy tubes are recommended for nutrition support predicted to last 2-3 months or more. A 2010 survey of pediatric health care providers at our institution demonstrated that 73% were unaware of these guidelines and 47% would consider a G tube only after 3-6 months.
OBJECTIVES: The objective of this study is to determine whether the duration of nasoenteral tube feeding in children at our centre is consistent with expert consensus guidelines.
DESIGN/METHODS: Prospectivechart review of all patients younger than 17 years of age referred for home nutrition support from January 2014 - July 2015 was conducted, with data collection until the present.
RESULTS: 310 children were referred for nutrition support. Excluding patients out of province, lost to follow-up or deceased within a year from referral, 237 children were included. 88% were initially fed with a nasoen-teral tube; 76% of them were predicted to require tube feeding for months to years. 70% were fed with a nasoenteral tube for more than 3 months, with a mean duration of 4.8 months (range 0.07-20.3 months). 10% eventually underwent gastrostomy tube insertion, with a mean time to insertion of 9.7 months (0.07-20.3 months).
CONCLUSION: The duration of nasoenteral tube feeding in a significant proportion of children is longer than recommended by expert consensus guidelines. An important contributing factor is lack of knowledge amongst pediatric health care practitioners about existing best practice guidelines.
The First Step to Helping: Asking About Poverty
Authors: Teicher J , Qadri J Ysselstein , Bloch G , Ford-Jones L , Orkin J 
Published: September 2022

Abstract
BACKGROUND: Canadian children living in poverty are more likely to experience poor health outcomes. Physicians have a unique opportunity to screen for poverty and other social determinants of health (SDOH) in order to intervene early and change their patients' health trajectories. It is well known in the literature to date that addressing SDOH in clinical practice can improve health outcomes, however, significant barriers have been identified that limit a physician’s ability to address these issues. The Child Poverty Assessment Tool (CPAT) was developed by an inter-professional team of physicians, social workers and community child health agency partners to provide healthcare providers with screening questions for the SDOH and resources to address identified SDOH needs. The tool was created to support physicians with links to the community and simple screening approaches to common social issues.
OBJECTIVES: To develop an understanding of physicians' current SDOH screening practices and attitudes to screening for the SDOH in clinical practice; To explore the feasibility, accessibility, and relevance of the CPAT for paediatricians at an academic health science centre.
DESIGN/METHODS: Using a qualitative grounded theory approach, seven consultant academic paediatricians were individually interviewed. The interviews were conducted using a semi-structured interview guide, and were digitally recorded and transcribed verbatim. Two team members independently coded the transcripts for recurrent themes. This project was undertaken as a Quality Improvement project and was conducted with appropriate ethical approval.
RESULTS: Three major themes emerged regarding benefits of screening for SDOH: improved assessment of social issues, increased referrals to community supports and agencies, and appropriate modifications to treatment plans as informed by social issues. In addition to limiting billing models and time constraints, five major themes were identified as challenges to screening for SDOH: lack of knowledge of resources, upsetting family expectations, the physician’s own comfort in asking questions regarding the SDOH, the biomedical model of training, and physicians' understanding of their scope of practice. The CPAT was found to address some, but not all of these challenges.
CONCLUSION: The results from the project elucidated important factors that influence the SDOH screening practices of paediatricians. While a structured tool (i.e. the CPAT) may provide support to physicians conducting screening, systemic and medical cultural barriers exist. Further research is needed to examine the effectiveness of implementing screening tools in clinical practice, and to identify solutions for systemic barriers to screening for poverty in paediatric populations.