bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing Breast Milk Production with Domperidone in Mothers of Preterm Neonates: A Randomized Controlled Trial (Empower Trial)
Authors: Asztalos E , Campbell-Yeo M , DaSilva O , Kiss A , Knoppert D , Ito S 
Published: September 2022

Abstract
BACKGROUND: Using mother’s own expressed breast milk (EBM) has a positive impact in reducing serious neonatal morbidities and improving neurodevelopmental outcomes for very preterm infants. Mothers often struggle to maintain a supply of EBM during prolonged hospitalization. In small studies, domperidone, a potent dopamine D2 receptor antagonist that stimulates the release of prolactin, has been shown to enhance EBM production.
OBJECTIVES: The primary objective was to determine whether administration of domperidone, within the first 21 days after delivery, would lead to a higher proportion of mothers having a 50% increase in the volume of EBM at the end of 14 days of treatment. The secondary objectives were to determine if a 28 day compared to a 14 day treatment yielded a higher proportion of mothers with a 50% increase in EBM volumes; and 2) to determine if a later initiation of domperidone differed in obtaining a 50% increase in EBM volume.
DESIGN/METHODS: EMPOWER was a multicenter, double masked, randomized controlled phase-II trial. Eligible mothers were randomized to one of two treatment arms: group A: domperidone 10 mg orally three times daily for 28 days; group B: identical placebo 10 mg orally three times daily for 14 days followed by domperidone 10 mg orally three times daily for 14 days.
RESULTS: A total of 90 mothers were randomized equally into the 2 arms; 82 were included in the analysis of the primary outcome. Baseline characteristics were similar between the two groups of mothers. There was a significant difference in the proportion of mothers who achieved a 50% increase in EBM volume at the end of the first 14 days of the study treatment: 77.8% in group A vs. 57.8% in group B [OR 0.39, 95% CI 0.16, 0.98, p=0.04] However, there was no difference in the proportion of mothers who achieved a 50% increase in EBM volume on day 28: 68.9% in group A vs. 66.7% in group B [OR .90, 95% CI 0.37, 2.19].
CONCLUSION: Introducing a galactogogue may be helpful in aiding mothers of preterm infants who present with an insufficient supply of EBM within the first 21 to 35 days after birth.
Awareness of Sentinel Injuries Among Canadian Paediatricians: A Cpsp One-Time Survey
Authors: Barrett R , Hanes L , Ornstein A 
Published: September 2022

Abstract
BACKGROUND: A sentinel injury is a visible or detectable minor injury in a pre-cruising infant that is poorly explained and therefore suspicious for physical abuse. Examples include bruises and intra-oral bleeding, which may be “warning injuries” for possible abuse. Timely recognition and management of a sentinel injury can potentially alter a pattern of escalating child abuse, but studies have demonstrated that in up to a third of cases, physicians miss early signs of abuse.
OBJECTIVES: Our purpose was to assess paediatrician awareness of sentinel injuries in pre-cruising children as precursors to more serious physical abuse.
DESIGN/METHODS: A Canadian Paediatric Surveillance Program (CPSP) one-time survey of Canadian paediatricians was conducted in March of 2015 to evaluate awareness of sentinel injuries and their significance. Respondents were provided with clinical vignettes describing infants with sentinel injuries and were asked questions about their differential diagnosis and management plan. Respondents were then classified as either “aware” or “not aware” based on their responses, and a multivariable logistic regression analysis was used to identify variables most strongly correlated with awareness.
RESULTS: The survey achieved a response rate of 23.4%. Of the 582 respondents, 65% were aware that bruises and intra-oral injuries in pre-cruising children are red flags for possible physical abuse. Respondents were more likely to be aware of bruises as sentinel injuries (91.9%) than they were of intra-oral injuries (67.2%). Paediatric subspecialists were significantly less likely than general paediatricians to be aware of sentinel injuries as red flags for later serious abuse (adjusted OR=0.57, 95% CI 0.37–0.88, p=0.01). Other important trends included higher awareness with more recent completion of residency, and also with additional training in the area of child abuse and neglect.
CONCLUSION: Over one-third of Canadian paediatricians are unaware that unexplained bruising and intra-oral bleeding in a pre-cruising child should prompt assessment for possible abuse. Further physician education is warranted to ensure that paediatricians understand the importance of sentinel injuries and the indications for initiating investigations to detect occult injuries of child abuse. Future directions include the development of physician training opportunities in the area of identifying and managing sentinel injuries, as well as extending the study population to include family physicians who provide primary care to children.
Midpoint Results of National Surveillance of Childhood Tuberculosis
Authors: Giroux R , Jamal A , Kitai I , Consunji-Araneta R , Baikie M , Morris SK 
Published: September 2022

Abstract
BACKGROUND: There is little detailed epidemiologic and clinical data about tuberculosis (TB) disease in children in Canada.
OBJECTIVES: To characterize the epidemiologic, clinical, and treatment data for all cases of TB in children under age 15 in Canada through the Canadian Pediatric Surveillance Program’s (CPSP) Childhood Tuberculosis Study. The initial results of the 3 year study presented here includes cases from September 2013 to October 2015.
DESIGN/METHODS: TB cases were identified through a monthly form sent by the CPSP to approximately 2500 active pediatricians, pediatric subspecialists, and select non-pediatricians who manage childhood TB. For cases meeting inclusion criteria, a detailed questionnaire was sent to collect clinical, epidemiological, and treatment data, followed by 6-month follow-up surveys until 6 months after treatment completion.
RESULTS: Of 164 unique incident cases reported, 84 met inclusion criteria and returned a detailed questionnaire. Selected demographic data is shown here:

Intrathoracic TB was reported in 78/84 (93%) of cases including 66 with pulmonary disease. One or more positive cultures were obtained in 32/68 (47%) of cases attempting pulmonary culture using sputum (n=17), bron-choalveolar lavage (n=2), and/or gastric aspirates (n=16). Of these, 4/9 (44%) were positive in children 12 months or younger, 8/23 (35%) between ages 1-4, 5/14 (36%) between ages 5-9, and 15/22 (68%) in children 10+ years. In two culture-negative cases, a positive AFB was found in the sputum. Extrathoracic TB was reported in 30% (n=25), with rates in children 10+ years being significantly higher than expected given the current literature. One case was MDR-TB.
CONCLUSION: Detailed clinical, epidemiological, and treatment data has been obtained for many cases of childhood TB in Canada through the CPSP Childhood Tuberculosis Study. This study will provide the most complete picture of childhood TB in Canada and will serve to refine practice in monitoring, detecting, and treating this infection.
Severe Bradycardia Following Initiation of Low-Dose Olanzapine in A Patient with Anorexia Nervosa
Authors: Mijovic H , Grant C , Couturier J 
Published: September 2022

Abstract
BACKGROUND: Low-dose Olanzapine has been used clinically for over a decade in anorexia nervosa (AN) patients failing standard treatment in order to decrease anxiety and facilitate weight gain. While Olanzapine has been generally well tolerated, large scale data regarding safety and side-effects in AN patients is lacking.
OBJECTIVES: To examine possible association between severe bradycar-dia and Olanzapine use in AN patients.
DESIGN/METHODS: Case study and literature review.
RESULTS: We present a case of severe bradycardia (HR 18) following initiation of low-dose Olanzapine in a 16 year old female admitted to our inpatient ward with AN and bradycardia during sleep.To our best knowl-edgeno other case studies of severe bradycardia in AN patients treated with Olanzapine have been published to date.We relate our case to findings from available literature that examines potential association between bradycardia and Olanzapine. We point to challenges with obtaining larger scale data on Olanzapine safety and side-effects in AN patients.
CONCLUSION: There areinherent cardiac risks associated with treatment of AN patients. Existing literature in patients with diagnosis other than AN suggests there may be inter-individual differences in pharmacoki-netics of Olanzapine and that bradycardia may be a possible adverse effect of Olanzapine even at a low dose. Caution should be used in initiating Olanzapine in AN patients with baseline bradycardia.
Family History-Taking in Paediatrics: It’s Much More Than Just A Checklist
Authors: Tessier L , Brehaut J , Potter B , Chakraborty P , Carroll J , Wilson B 
Published: September 2022

Abstract
BACKGROUND: Family history (FH) is a risk factor for many conditions in pediatric practice; interest has increased in supporting systematic FH taking in this area by identifying core conditions for enquiry and developing point of care tools. There is little published about current practice to inform implementing such changes.
OBJECTIVES: To inform future FH taking interventions by identifying pediatricians' perceptions, attitudes, beliefs, and current practices.
DESIGN/METHODS: The Theoretical Domains Framework (TDF) was used to develop a comprehensive interview scheme. Semi-structured interviews were conducted with community and hospital-based pediatricians Analysis was by the constant comparison method, using a thematic approach. This study was funded by the Canadian Institutes of Health Research.
RESULTS: The data revealed FH taking to be a firmly embedded, but complex aspect of pediatric practice. Participants described FH as part of regular, holistic care, extending to social and interpersonal, as well as clinical purposes; in addition to disease risk assessment, FH information helped clarify diagnosis, and select medication; tailor the overall patient management based on family circumstances; and provide psychosocial support for parents. It was also used as a method to build a relationship with parents/carers. FH and social history information were inextricably linked and often appeared to be the same concept in participants’ minds. Participating pediatricians generally expressed confidence in their FH skills and reported tailoring their approach according to experience, after initial training early in their career. While acknowledging some challenges in ensuring accuracy, they were attuned to nuances in their interactions with parents and children which would affect whether, and what, they were told about illness in the family. Most were not concerned about formal evidence, and would not change their practice except for “good reason”.
CONCLUSION: The use of the TDF helped ensure a comprehensive approach to FH taking in pediatric practice. The findings suggest that FH taking in this setting is a complex activity, embedded in routine care. Recommendations for systematic enquiry about specific conditions cannot be seen as a simple additional activity to current practice. Efforts to make FH taking more systematic may founder if they fail to take into account pediatricians’ attitudes, perspectives, and practices. Further studies should explore and seek to confirm and expand our observations.
Developmental Delay? Graduating Medical Students’ Knowledge of Child Development
Authors: MacPherson P , Bischoff M , North CR , Tough S , Andrews D 
Published: September 2022

Abstract
BACKGROUND: Knowledge of child development is fundamental to medical practice. Previous studies have demonstrated gaps in knowledge and training among trainees and practicing physicians. We conducted a longitudinal study of medical students’ knowledge of child development. Previously, we reported that students’ knowledge of developmental milestones was poor at baseline, did not improve after preclinical teaching and improved marginally after pediatrics clerkship. Here, we report the report the data on graduating medical students.
OBJECTIVES: The present study aimed to describe graduating medical students’ knowledge of developmental milestones in comparison to their baseline knowledge. A secondary aim was to compare graduating students' knowledge to that of the general population.
DESIGN/METHODS: We assessed medical students' knowledge of developmental milestones using a previously published 17-item questionnaire. Milestones were categorized as motor or non-motor. Students were surveyed at the start of medical school in Year 1 and prior to graduation in Year 4. Changes in students' scores were assessed using paired t-tests. Graduating medical students were compared to a published general population sample using t-tests.
RESULTS: 56 students completed the survey in both Years 1 and 4 (33% of entering class). Overall, students’ percentage of correct answers increased from 24% at baseline to 32% at graduation (p&lt;0.001). Knowledge of motor milestones did not change significantly between Years 1 and 4. Knowledge of non-motor milestones improved significantly between Years 1 and 4 (p&lt;0.001). 85 medical students completed the questionnaire in Year 4 (50% of entering class). Compared to a sample of the general population (n=1198), graduating medical students answered 1.0 more questions correctly out of 17 (p&lt;0.001). Students’ knowledge of non-motor milestones was greater than that of the general population (p&lt;0.001). Knowledge of motor milestones did not differ significantly.
CONCLUSION: Medical students' knowledge of developmental milestones improved only modestly over the course of their undergraduate medical education. At graduation, their knowledge of developmental milestones was marginally better than that of the general population. This level of knowledge is likely insufficient for generalist practice. At the undergraduate level, curricular improvements including innovative teaching strategies and greater student engagement are likely necessary to remediate this knowledge gap. Pediatricians supervising medical students and residents should not assume that trainees have an adequate knowledge of normal child development and may wish to highlight the developmental achievements of typically developing children as part of their clinical teaching.
Screening for Risk of Developmental Delay in a primary care setting using the Nippising District Developmental Screen
Authors: Zabih W , Parkin P , Borkhoff C , Heuvel M Van den , Korosheygi C , Maguire J , Birken C , Cairney J ,   TARGet Kids!
Published: September 2022

Abstract
BACKGROUND: Early growth and development in the first five years of life is strongly associated with health outcomes. The Nipissing District Developmental Screen (NDDS) is a free parent-reported screening tool recommended by the Canadian Pediatric Society as one of the tools for developmental screening in children
OBJECTIVES: To determine the prevalence of a positive screen for risk of developmental delay in a cohort of healthy children at 18-months and 5 years. To identify risk factors (child, socio-demo-graphic and home environment) associated with a positive screen for risk of developmental delay.
DESIGN/METHODS: A cross-sectional study of healthy Canadian children attending 18-months and 5 year well-child visits between June 2008 and February 2015 was conducted through the TARGet Kids! practice-based research network. Multivariable logistic regression was used to identify risk factors associated with a positive screen for developmental delay. Risk factors of development delay identified from literature were:, male sex, low birth weight, low income, low maternal education, maternal unemployment, non-industrialized immigrant status, single parent family, only child and older maternal age.
RESULTS: 1086 children (53% male) at 18 months and 575 children (51% male) at 5 years were included in the final analysis. At 18 months, 341 (31.4%) of children (95% CI, 28.7% - 34.3%) and at 5 years 166 (28.9%) (95% CI, 25.2% -32.8%) were screen positive base on 1+ flag NDDS. At 18 months, children with a low birthweight (OR=1.66; 95% CI 1.22-2.28), with a mother with low education (OR=1.75; 95% CI 1.07-2.85), and those from non-industrialized immigrant families (OR=1.85; 95% CI 1.37-2.49) were associated with an increased odds of a positive screen for developmental delay based on the 1+ NDDS flag. A female child (OR=0.74; 95% CI 0.57-0.96) and an only child (OR=0.76; 95% CI 0.57-0.99) were associated with a decreased odds of a positive screen for developmental delay. At 5 years, factors associated with a positive screen for developmental delay based on the 1+ NDDS flag were: low maternal education (OR 2.24; 95% CI 1.14-4.39) (children had 2.24 times greater odds of a positive screen for developmental delay) and older maternal age (OR 1.05; 95% CI 1.00-1.09) (every 1-year increase in maternal age, children had 1.05 times greater odds of a positive screen for developmental delay). A female child was associated with a decreased odds of a positive screen for developmental delay (OR=0.66; 95% CI 0.46-0.96) based on the 1+ NDDS flag.
CONCLUSION: In a population of healthy urban children the NDDS identified 30% at both 18 month and 5 years at risk for developmental delay. Risk factors for developmental delay were associated with a positive NDDS screen.
Incident Reporting as A Quality Improvement Tool in Paediatric Resuscitations
Authors: Ratnapalan S , Kelly I , Fearey L 
Published: September 2022

Abstract
BACKGROUND: A code is called through locating for any child under 16 years of age who requires resuscitation in our hospital and a team of physicians, nurses and resuscitation officers attend these resuscitations. All clinicians involved in the resuscitation are sent a standardised questionnaire by the resuscitation office to identify issues during that resuscitation which may not be captured elsewhere. This feedback system was established to create a mechanism for anonymous feedback from all members of resuscitation teams.
OBJECTIVES: The objective of this study was to identify the teams' perception of issues in clinical care and remedial actions that were implemented by the institution to address these gaps.
DESIGN/METHODS: A retrospective review of all voluntary anonymous survey responses that were generated at our institution from January to December 2013 was conducted after Research Ethics Board review and approval. A narrative analysis was conducted by the Resuscitation Officersand a Paediatric Emergency Consultant to identify themes and categories.
RESULTS: There were 56 medical and 49 trauma resuscitations occurred in 2013 of which all traumas (49) and 48 (86%) of medical resuscitations were in the emergency department There were fully or partially completed surveys available for 97 resuscitations that occurred in the emergency department during the study period. Major themes with positive comments included; the team lead from the emergency department and clear role identification during the resuscitations. Identified themes with concerns included providers’ knowledge gaps, process delays due to equipment issues and system issues. Knowledge gaps regarding drowning management, protocols for cardiopulmonary resuscitations, and lack of clarity regarding policies and procedures when a child is certified dead after resuscitation were identified. Equipment delays for paediatric resuscitation were due to absent batteries in laryngoscope, suction failure, lack of small cuffed endotracheal tubes in ED, inability to find oxygen saturation connectors, and lack of enteral syringes in resuscitation areas. The system issues that were identified included inadequate space in the resuscitation room, in-adequate number of lead aprons when there were more than one trauma case, specimen transport delays and delays in accessing paediatric sub-speciality services.
CONCLUSION: Issues with resuscitations can be identified through anonymous feedback even when robust systems and processes are in place to ensure appropriate personnel and equipment are readily available at paediatric resuscitations. Our study identified provider, process and system issues in paediatric resuscitations which helped to identify strategies to improve service delivery.
Rotavirus Genotypes Circulating in Ontario, Canada, Before and After the Implementation of the Immunization Program, 2010-2013
Authors: Isabel S , Higgins RR , Peci A , Deeks S L. , Gubbay JB 
Published: September 2022

Abstract
BACKGROUND: Rotavirus A is a common cause of acute gastroenteritis in young children and a significant cause of death worldwide. Rotavirus shows an impressive genetic diversity and its epidemiological surveillance is typically conducted with a binary genotyping system using two major outer capsid antigenic protein genes: G (VP7 gene) and P (VP4 gene). Ontario introduced a publicly funded vaccination program for two and four month old infants for rotavirus in August 2011, using Rotarix® (GlaxoSmithKline), a live monovalent oral vaccine which contains an attenuated G1P[8] strain. Rotavirus vaccination has diminished the magnitude of rotavirus seasons in many countries but it is unclear if it will contribute to selective pressure and increase the prevalence of other genotypes.
OBJECTIVES: Our aim was to describe circulating rotavirus genotypes before and after the implementation of Ontario’s immunization program. We monitored the potential change in relative proportions and emergence of rotavirus genotypes in Ontario after vaccination-program implementation.
DESIGN/METHODS: Rotavirus detection was conducted at a public health laboratory using electronic microscopy, immunochromatographic testing, and/or laboratory developed multiplex rRT-PCR. A convenience sample of rotavirus positive stool specimens collected in children and adults in Ontario from September 2010 to June 2013 were genotyped using heminested genotyping multiplex PCR. We also searched Pubmed in November 2015 for articles published on rotavirus G10 since 2008.
RESULTS: Of the 332 stool specimens collected, we found a decrease in the number of rotavirus positive specimens available for genotyping in the 23 month period post-vaccination (128 specimens) compared to the 11 month period pre-vaccination (204 specimens) in Ontario. We also found an increase in the proportion of genotype G10 in the post-vaccination period (37/128 = 29%) compared to the pre-vaccination period (11/204 = 5%). These G10 specimens originated from different regions of Ontario. Our literature review estimated that only approximately two hundred G10-positive human stool samples were reported from 14 different countries worldwide since 2008.
CONCLUSION: Our study showed a decrease in the number of rotavi-rus positive convenience samples after vaccination-program implementation. We also found an unexpected increase of the proportion of rotavirus G10 after the introduction of the immunization program. Genotype G10 is uncommon in human and vaccine effectiveness for this genotype is unclear.Ongoing monitoring of rotavirus prevalence and circulating genotypes is important to study the long-term effect of vaccination and evaluate if this increase in proportion of genotype G10 is representative or persists in Ontario, or is present in other Canadian provinces or countries.