Jessy Burns, Ryan Phung, Shayna McNeill, Ana Hanlon-Dearman, M Florencia Ricci
Abstract Background Autism Spectrum Disorder (ASD) is a developmental disorder characterized by deficits in social interaction/communication, restricted interests and repetitive behaviours. Recent discussions have emerged worldwide regarding a possible “overly-inclusive” diagnosis of ASD, adding heterogeneity around presentation/etiology and comorbidities. Objectives This study aimed to determine the frequency and characteristics of comorbidities among children diagnosed with ASD in Manitoba, and to evaluate differences in presentation between those with and without medical comorbidities. As comorbid neurodevelopmental disorders such as global developmental delay (GDD) and attention-deficit yyperactivity disorder (ADHD) are common in children with ASD, these were not included as “medical comorbidities” and were studied separately. Design/Methods We conducted a retrospective chart review of >2000 electronic charts at the main referral site for children <6 years requiring evaluation for ASD in Manitoba. All children aged 0-5 years diagnosed with ASD at this site between May 2016 to September 2021 were identified. X2 and t test were used to compare groups. Results Of the total of 1858 children identified, 1459 (78%) were male, 252 (13.5%) were born prematurely, 504 (27%) had ≥1 medical comorbidity. Most common medical comorbidities were neurological (12.7%) and allergies/eczema (6.1%). Comorbid GDD was diagnosed in 428 (23%). Age of referral to RCC and age of diagnosis did not differ between groups. Medical comorbidities were more common among preterm children (31% vs. 26%, p:<0.01) and children with comorbid GDD (35% vs. 18.6%, p:<0.01). There was no significant difference in overall presence of medical comorbidities by sex (29.5% vs. 26.6%, p: 0.25); however, girls had a statistically significant higher incidence of neurological comorbidities, e.g. cerebral palsy, epilepsy, hypotonia NYD (16% vs. 12%, p:0.03). Conclusion Results of this study are consistent with previous studies, which note high comorbidity rates among children with ASD. The high rates of associated neurological conditions, GDD, and prematurity add heterogeneity to this group and may relate to the reported “overly-inclusive” diagnosis. This study will be used as a catalyst for guiding further prospective studies in the area.
自闭症谱系障碍(Autism Spectrum Disorder, ASD)是一种以社会交往/沟通缺陷、兴趣限制和重复性行为为特征的发育障碍。最近在世界范围内出现了关于ASD诊断可能“过度包容”的讨论，增加了表现/病因和合并症的异质性。目的本研究旨在确定曼尼托巴省诊断为ASD的儿童共病的频率和特征，并评估有和没有医学共病的儿童在表现上的差异。由于整体发育迟缓(GDD)和注意力缺陷多动障碍(ADHD)等共病性神经发育障碍在ASD儿童中很常见，因此这些未被纳入“医学共病”，并被单独研究。设计/方法我们对马尼托巴省6岁以下需要评估ASD的儿童主要转诊点的2000张电子图表进行了回顾性分析。所有在2016年5月至2021年9月期间被诊断为ASD的0-5岁儿童均被确定。组间比较采用X2检验和t检验。结果1858例患儿中，男性1459例(78%)，早产252例(13.5%)，合并症504例(27%)。最常见的医学合并症是神经系统(12.7%)和过敏/湿疹(6.1%)。428人(23%)被诊断为共病性GDD。转介到RCC的年龄和诊断年龄在两组之间没有差异。医疗合并症在早产儿(31%比26%，p:<0.01)和患有GDD合并症的儿童(35%比18.6%，p:<0.01)中更为常见。医学合并症的总体存在性在性别上没有显著差异(29.5% vs 26.6%， p: 0.25);然而，女孩的神经系统合并症发生率有统计学上的显著性增高，如脑瘫、癫痫、低张力NYD(16%比12%，p:0.03)。结论本研究结果与先前的研究一致，即ASD患儿的合并症发生率较高。相关神经系统疾病、GDD和早产的高发生率增加了该组的异质性，并可能与报道的“过度包容”诊断有关。本研究将作为指导该领域进一步前瞻性研究的催化剂。
{"title":"14 Comorbidities Affecting Children with Autism Spectrum Disorder: A Retrospective Chart Review from the Main Referral Site for ASD Evaluation in Manitoba","authors":"Jessy Burns, Ryan Phung, Shayna McNeill, Ana Hanlon-Dearman, M Florencia Ricci","doi":"10.1093/pch/pxad055.014","DOIUrl":"https://doi.org/10.1093/pch/pxad055.014","url":null,"abstract":"Abstract Background Autism Spectrum Disorder (ASD) is a developmental disorder characterized by deficits in social interaction/communication, restricted interests and repetitive behaviours. Recent discussions have emerged worldwide regarding a possible “overly-inclusive” diagnosis of ASD, adding heterogeneity around presentation/etiology and comorbidities. Objectives This study aimed to determine the frequency and characteristics of comorbidities among children diagnosed with ASD in Manitoba, and to evaluate differences in presentation between those with and without medical comorbidities. As comorbid neurodevelopmental disorders such as global developmental delay (GDD) and attention-deficit yyperactivity disorder (ADHD) are common in children with ASD, these were not included as “medical comorbidities” and were studied separately. Design/Methods We conducted a retrospective chart review of &gt;2000 electronic charts at the main referral site for children &lt;6 years requiring evaluation for ASD in Manitoba. All children aged 0-5 years diagnosed with ASD at this site between May 2016 to September 2021 were identified. X2 and t test were used to compare groups. Results Of the total of 1858 children identified, 1459 (78%) were male, 252 (13.5%) were born prematurely, 504 (27%) had ≥1 medical comorbidity. Most common medical comorbidities were neurological (12.7%) and allergies/eczema (6.1%). Comorbid GDD was diagnosed in 428 (23%). Age of referral to RCC and age of diagnosis did not differ between groups. Medical comorbidities were more common among preterm children (31% vs. 26%, p:&lt;0.01) and children with comorbid GDD (35% vs. 18.6%, p:&lt;0.01). There was no significant difference in overall presence of medical comorbidities by sex (29.5% vs. 26.6%, p: 0.25); however, girls had a statistically significant higher incidence of neurological comorbidities, e.g. cerebral palsy, epilepsy, hypotonia NYD (16% vs. 12%, p:0.03). Conclusion Results of this study are consistent with previous studies, which note high comorbidity rates among children with ASD. The high rates of associated neurological conditions, GDD, and prematurity add heterogeneity to this group and may relate to the reported “overly-inclusive” diagnosis. This study will be used as a catalyst for guiding further prospective studies in the area.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Esther Lee, Nilanga Aki Bandara, Xuan Randy Zhou, Emily Booy
Abstract Background Feeding tubes have become an important part of care for children with various health conditions. Using gastrojejunal (GJ) tubes is increasingly common in children who do not tolerate gastric feeding. There are some recent articles that show GJ tubes are safe for children. Despite the increasing number of children who require these feeding tubes and their associated safety profile, health care professionals do not have adequate education on GJ tube use. This can impact the care received by children who require GJ tubes. Further, it is necessary to consider the experiences of caregivers who support these children. Objectives There appears to be a paucity of synthesized data on GJ tube use in paediatrics in the academic literature. Therefore, the aim of this review is to bring forward literature reflecting clinical indications for placement, standardized pathways, quality improvement initiatives, and the experiences of patients, families, and caregivers. This will help us better understand the relationship that GJ tubes have with various stakeholders involved in healthcare. Design/Methods A scoping review was undertaken on Embase, Medline and Web of Science. The search parameters were built with the assistance of a subject expert librarian. All articles were uploaded and screened using the Covidence research management software. Following automatic duplicate removal on Covidence, a total of 2,154 articles of interest were found. Following abstract and title screening, 142 articles were assessed in the full-text review stage. Finally, after full-text review, 97 articles were included for data extraction. Refer to Figure 1. One member of our research team is the parent of a child who used a GJ tube, whose role is to review our search criteria as well as results. Results There are several clinical indicators for GJ tube placement, such as neurological, gastrointestinal, respiratory, cardiovascular, and surgical-related indications. Also, GJ tubes are more often placed as an alternative to fundoplication. Often a GJ tube is placed subsequent to a gastric tube for patients who were unable to tolerate gastric feedings. In considering standardized pathways, a variety of initiatives have been initiated and assessed with the goal of increasing the efficiency of tube placements. Various benefits have been documented as a result of the implementation of these standardized pathways, including reduced health visits to the emergency department and shorter postoperative stays in the hospital. There have been various quality improvement initiatives also, ranging from surgical innovations regarding tube placement, tube complication reduction initiatives, and certain considerations for specific populations who may have additional support needs. For patients, there were several documented benefits for children, such as improved weight. There were also increases in satisfaction of the child and parent/caregiver. Regarding placement, it was found tha
摘要背景饲管已成为各种健康状况儿童护理的重要组成部分。胃空肠(GJ)管在不耐受胃喂养的儿童中越来越常见。最近有一些文章表明GJ管对儿童是安全的。尽管越来越多的儿童需要这些喂食管及其相关的安全性，但卫生保健专业人员对GJ管的使用缺乏充分的教育。这可能会影响需要GJ管的儿童接受的护理。此外，有必要考虑照顾这些儿童的人的经历。在学术文献中，关于GJ管在儿科使用的综合数据似乎缺乏。因此，本综述的目的是提出反映安置的临床适应症、标准化途径、质量改进举措以及患者、家庭和护理人员经验的文献。这将帮助我们更好地理解GJ管与医疗保健中涉及的各种利益相关者之间的关系。设计/方法在Embase、Medline和Web of Science上进行范围综述。检索参数在学科专家馆员的协助下建立。所有文章均通过新冠病毒研究管理软件上传并筛选。在covid上自动删除重复后，共发现了2154篇感兴趣的文章。摘要和标题筛选后，142篇文章进入全文评审阶段。最后，经过全文审阅，纳入97篇文章进行数据提取。参见图1。我们研究小组的一名成员是使用GJ试管的孩子的父母，他的作用是审查我们的搜索标准和结果。结果GJ管置入术的临床适应症包括神经、胃肠、呼吸、心血管和外科相关适应症。此外，GJ管更常被放置作为基础复制的替代方案。对于不能耐受胃喂养的患者，通常在胃管之后放置GJ管。在考虑标准化路径时，已经启动并评估了各种旨在提高管道放置效率的举措。由于实施了这些标准化的途径，已经记录了各种好处，包括减少到急诊科的就诊次数和缩短术后住院时间。也有各种质量改进措施，包括关于导管放置的手术创新，减少导管并发症的措施，以及对可能有额外支持需求的特定人群的某些考虑。对病人来说，有几个记录在案的好处，比如改善体重。孩子和父母/照顾者的满意度也有所提高。在放置方面，我们发现父母经常感到压力，有时对试管放置过程不知情。结论:本综述强调了儿童与GJ管相关的各种领域。这些信息可以为参与医疗保健流程的利益相关者提供支持。接下来，需要对特定领域进行额外的审查，以评估数据的质量并突出未来的方向。
{"title":"12 What is the Evidence? Gastrojejunal (GJ) Tubes for Children: A Scoping Review","authors":"Esther Lee, Nilanga Aki Bandara, Xuan Randy Zhou, Emily Booy","doi":"10.1093/pch/pxad055.012","DOIUrl":"https://doi.org/10.1093/pch/pxad055.012","url":null,"abstract":"Abstract Background Feeding tubes have become an important part of care for children with various health conditions. Using gastrojejunal (GJ) tubes is increasingly common in children who do not tolerate gastric feeding. There are some recent articles that show GJ tubes are safe for children. Despite the increasing number of children who require these feeding tubes and their associated safety profile, health care professionals do not have adequate education on GJ tube use. This can impact the care received by children who require GJ tubes. Further, it is necessary to consider the experiences of caregivers who support these children. Objectives There appears to be a paucity of synthesized data on GJ tube use in paediatrics in the academic literature. Therefore, the aim of this review is to bring forward literature reflecting clinical indications for placement, standardized pathways, quality improvement initiatives, and the experiences of patients, families, and caregivers. This will help us better understand the relationship that GJ tubes have with various stakeholders involved in healthcare. Design/Methods A scoping review was undertaken on Embase, Medline and Web of Science. The search parameters were built with the assistance of a subject expert librarian. All articles were uploaded and screened using the Covidence research management software. Following automatic duplicate removal on Covidence, a total of 2,154 articles of interest were found. Following abstract and title screening, 142 articles were assessed in the full-text review stage. Finally, after full-text review, 97 articles were included for data extraction. Refer to Figure 1. One member of our research team is the parent of a child who used a GJ tube, whose role is to review our search criteria as well as results. Results There are several clinical indicators for GJ tube placement, such as neurological, gastrointestinal, respiratory, cardiovascular, and surgical-related indications. Also, GJ tubes are more often placed as an alternative to fundoplication. Often a GJ tube is placed subsequent to a gastric tube for patients who were unable to tolerate gastric feedings. In considering standardized pathways, a variety of initiatives have been initiated and assessed with the goal of increasing the efficiency of tube placements. Various benefits have been documented as a result of the implementation of these standardized pathways, including reduced health visits to the emergency department and shorter postoperative stays in the hospital. There have been various quality improvement initiatives also, ranging from surgical innovations regarding tube placement, tube complication reduction initiatives, and certain considerations for specific populations who may have additional support needs. For patients, there were several documented benefits for children, such as improved weight. There were also increases in satisfaction of the child and parent/caregiver. Regarding placement, it was found tha","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manisha Bharadia, Zoë Dworsky-Fried, Mackenzie Moir, Manasi Rajagopal, Serge Gouin, Scott Sawyer, Stephanie Pellerin, Lise Bourrier, Naveen Poonai, Antonia Stang, Michael van Manen, Samina Ali
Abstract Background Parents/caregivers are often the gatekeepers for the pharmacologic management of their children’s pain. Parents’ unique expertise in assessing their children’s pain reactions, alongside a deep emotional drive to protect their children, make them invaluable advocates and partners. Parents are highly invested in optimizing pain management outcomes for children. Concerns and preferences regarding medications, including opioids, influence their choices. An improved understanding of caregiver decision-making should encourage a family-centred approach to communication with parents when deciding analgesic plans for children with acute pain, facilitate shared clinical decision-making, and optimize paediatric pain management outcomes in the clinical setting. Objectives Our primary objective was to explore and understand caregiver decision-making as it relates to acute pain management for children presenting to the emergency department, with particular focus on opioids. Design/Methods This qualitative study was embedded within an ongoing paediatric clinical trial (‘The No OUCH Trials’, NCT03767933), which aims to evaluate the clinical efficacy of a combination of oral opioid (hydromorphone) and non-opioid (ibuprofen and acetaminophen) analgesics to manage paediatric musculoskeletal injury-related pain. This study employed one-on-one semi-structured interviews. Parents of children with acute musculoskeletal injuries were recruited from three Canadian paediatric emergency departments (Stollery Children’s Hospital [Edmonton, Alta.], CHU Sainte-Justine [Montreal, Qué.], and Winnipeg Children’s Hospital [Winnipeg, Man.]). Interviews were conducted via telephone from June 2019 to March 2021. Verbatim transcription and thematic analyses occurred concurrently with data collection, supporting data saturation and theory development considerations. Results Twenty-seven interviews were completed. Five major themes regarding pain assessment and treatment emerged: a) My child’s comfort is a priority; b) Every situation is unique; c) Opioids only if necessary; d) Considerations when choosing opioids; and e) Pain research is important. Overall, parents were highly comfortable with their assessment of their child’s pain. Participants’ willingness to use opioid analgesia for their children was primarily dependent on perceptions of injury and pain severity. Although considerations for opioid use were similar between opioid-averse and opioid-willing families, the trade-offs between maximizing pain relief and minimizing risks were weighed differently. Conclusion Our study revealed that parents assess their child’s pain and distress as a global entity, with great confidence in their own assessment and decision-making. For most parents, the desire to relieve their children’s pain outweighed concerns of addiction, misuse, and adverse events when making decisions about opioid analgesia for short-term use. These results can inform evidence-based family-centred a
背景父母/照顾者往往是孩子疼痛药物管理的把关人。父母在评估孩子的疼痛反应方面的独特专长，以及保护孩子的深层情感驱动，使他们成为宝贵的倡导者和合作伙伴。父母在优化儿童疼痛管理结果方面投入了大量资金。对药物(包括阿片类药物)的担忧和偏好会影响他们的选择。提高对护理人员决策的理解应鼓励以家庭为中心的方法与父母沟通，以决定急性疼痛儿童的镇痛方案，促进共享临床决策，并优化临床环境中的儿科疼痛管理结果。我们的主要目标是探索和理解护理人员的决策，因为它与急诊科儿童的急性疼痛管理有关，特别关注阿片类药物。设计/方法:本定性研究纳入一项正在进行的儿科临床试验(“The No OUCH Trials”，NCT03767933)，旨在评估口服阿片类药物(氢吗啡酮)和非阿片类药物(布洛芬和对乙酰氨基酚)镇痛药联合治疗儿童肌肉骨骼损伤相关疼痛的临床疗效。本研究采用一对一半结构化访谈。急性肌肉骨骼损伤儿童的父母从加拿大三家儿科急诊科(斯托勒里儿童医院[埃德蒙顿，阿尔塔省])招募。， CHU Sainte-Justine[蒙特利尔，ququire]。和温尼伯儿童医院[温尼伯，曼.])。采访于2019年6月至2021年3月期间通过电话进行。逐字抄写和专题分析与数据收集同时进行，支持数据饱和和理论发展考虑。结果共完成27次访谈。关于疼痛评估和治疗的五个主要主题出现了:a)我孩子的舒适是优先考虑的;b)每个情况都是独一无二的;c)仅在必要时使用阿片类药物;d)选择阿片类药物时的考虑因素;e)疼痛研究很重要。总的来说，父母对他们对孩子疼痛的评估非常满意。参与者是否愿意为他们的孩子使用阿片类镇痛药主要取决于对损伤和疼痛严重程度的感知。尽管阿片类药物使用的考虑因素在阿片类药物厌恶家庭和阿片类药物愿意家庭之间是相似的，但在最大限度地缓解疼痛和最大限度地降低风险之间的权衡是不同的。我们的研究表明，父母将孩子的痛苦和困扰作为一个整体来评估，对自己的评估和决策有很大的信心。对于大多数父母来说，在决定短期使用阿片类镇痛药时，减轻孩子疼痛的愿望超过了对成瘾、滥用和不良事件的担忧。这些结果可以为以证据为基础的以家庭为中心的方法提供信息，以共同决策急性疼痛儿童的镇痛计划。
{"title":"75 Factors that Influence Parental Decision-making Regarding Analgesia for their Children with Musculoskeletal Injury-related Pain: A Qualitative Study","authors":"Manisha Bharadia, Zoë Dworsky-Fried, Mackenzie Moir, Manasi Rajagopal, Serge Gouin, Scott Sawyer, Stephanie Pellerin, Lise Bourrier, Naveen Poonai, Antonia Stang, Michael van Manen, Samina Ali","doi":"10.1093/pch/pxad055.075","DOIUrl":"https://doi.org/10.1093/pch/pxad055.075","url":null,"abstract":"Abstract Background Parents/caregivers are often the gatekeepers for the pharmacologic management of their children’s pain. Parents’ unique expertise in assessing their children’s pain reactions, alongside a deep emotional drive to protect their children, make them invaluable advocates and partners. Parents are highly invested in optimizing pain management outcomes for children. Concerns and preferences regarding medications, including opioids, influence their choices. An improved understanding of caregiver decision-making should encourage a family-centred approach to communication with parents when deciding analgesic plans for children with acute pain, facilitate shared clinical decision-making, and optimize paediatric pain management outcomes in the clinical setting. Objectives Our primary objective was to explore and understand caregiver decision-making as it relates to acute pain management for children presenting to the emergency department, with particular focus on opioids. Design/Methods This qualitative study was embedded within an ongoing paediatric clinical trial (‘The No OUCH Trials’, NCT03767933), which aims to evaluate the clinical efficacy of a combination of oral opioid (hydromorphone) and non-opioid (ibuprofen and acetaminophen) analgesics to manage paediatric musculoskeletal injury-related pain. This study employed one-on-one semi-structured interviews. Parents of children with acute musculoskeletal injuries were recruited from three Canadian paediatric emergency departments (Stollery Children’s Hospital [Edmonton, Alta.], CHU Sainte-Justine [Montreal, Qué.], and Winnipeg Children’s Hospital [Winnipeg, Man.]). Interviews were conducted via telephone from June 2019 to March 2021. Verbatim transcription and thematic analyses occurred concurrently with data collection, supporting data saturation and theory development considerations. Results Twenty-seven interviews were completed. Five major themes regarding pain assessment and treatment emerged: a) My child’s comfort is a priority; b) Every situation is unique; c) Opioids only if necessary; d) Considerations when choosing opioids; and e) Pain research is important. Overall, parents were highly comfortable with their assessment of their child’s pain. Participants’ willingness to use opioid analgesia for their children was primarily dependent on perceptions of injury and pain severity. Although considerations for opioid use were similar between opioid-averse and opioid-willing families, the trade-offs between maximizing pain relief and minimizing risks were weighed differently. Conclusion Our study revealed that parents assess their child’s pain and distress as a global entity, with great confidence in their own assessment and decision-making. For most parents, the desire to relieve their children’s pain outweighed concerns of addiction, misuse, and adverse events when making decisions about opioid analgesia for short-term use. These results can inform evidence-based family-centred a","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background Antimicrobial resistance is one of the greatest threats to global health. Antibiotic overuse drives antimicrobial resistance. Suspected urinary tract infection (UTI) is a key area of over-prescribing in many clinical settings but has not been investigated in the paediatric emergency department (ED). Objectives Here, we explore compliance with national UTI management guidelines in a paediatric emergency department setting and characterize patient and provider factors associated with guideline non-compliance. Design/Methods We performed retrospective chart review of patients ages 60 days to 36 months, discharged with a diagnosis of UTI from a single, urban, tertiary care paediatric emergency department (PED) with a diagnosis of UTI. Random visits were chosen using a computer algorithm. Primary outcomes were: 1) proportion of patients receiving guideline-compliant investigation and treatment, and 2) the proportion of children whose antibiotic prescriptions were appropriately adjusted upon return of urine culture and antibiotic susceptibilities (C&S). The guideline was the Canadian Paediatric Society statement on management of UTI, as well as the BC Children’s Hospital institutional UTI management guideline. Descriptive statistics and odds ratios between associations were calculated. Results We reviewed 402 charts. The proportion of infants receiving guideline-compliant testing and treatment was 25.9% (95% CI: 21.8-30.4%). Of those who were prescribed antibiotics, 79.6% (95% CI: 74.7-83.8%) received a first-line recommended agent and 58.9% (95% CI: 53.8-63.8%) received fully compliant therapy with respect to agent, dose, duration, and frequency. 19.4% (15.4-24.2%) of patients who were prescribed empiric cephalexin received an inappropriately high total daily dose. The proportion of patients receiving age-appropriate testing method was 52.2% (95% CI: 47.4-57.1). Febrile children were more likely to receive age-appropriate urine sample collection by catheterized sample (OR: 2.77 95% CI: 1.81-4.25) compared with afebrile children. Ultimately, 50.7% (95% CI: 40.4-49.6%) of patients discharged with a diagnosis of UTI and prescription for antibiotic met diagnostic criteria for UTI based on urinalysis and culture results. Of patients whose C&S mandated a change in therapy, 60.8% (95% CI: 55.8-65.7%) had their agent changed or discontinued. Conclusion Paediatric emergency medicine physicians frequently order inappropriate investigation and empiric treatment of UTI in young children. Discontinuation of empiric antibiotics in culture-negative children may be an impactful stewardship intervention in the PED.
{"title":"47 Clinical Approach to Febrile Urinary Tract Infections in Young Children Presenting to the Paediatric Emergency Department: A Retrospective Study of National Guideline Compliance","authors":"Frances Morin, Neil Desai","doi":"10.1093/pch/pxad055.047","DOIUrl":"https://doi.org/10.1093/pch/pxad055.047","url":null,"abstract":"Abstract Background Antimicrobial resistance is one of the greatest threats to global health. Antibiotic overuse drives antimicrobial resistance. Suspected urinary tract infection (UTI) is a key area of over-prescribing in many clinical settings but has not been investigated in the paediatric emergency department (ED). Objectives Here, we explore compliance with national UTI management guidelines in a paediatric emergency department setting and characterize patient and provider factors associated with guideline non-compliance. Design/Methods We performed retrospective chart review of patients ages 60 days to 36 months, discharged with a diagnosis of UTI from a single, urban, tertiary care paediatric emergency department (PED) with a diagnosis of UTI. Random visits were chosen using a computer algorithm. Primary outcomes were: 1) proportion of patients receiving guideline-compliant investigation and treatment, and 2) the proportion of children whose antibiotic prescriptions were appropriately adjusted upon return of urine culture and antibiotic susceptibilities (C&S). The guideline was the Canadian Paediatric Society statement on management of UTI, as well as the BC Children’s Hospital institutional UTI management guideline. Descriptive statistics and odds ratios between associations were calculated. Results We reviewed 402 charts. The proportion of infants receiving guideline-compliant testing and treatment was 25.9% (95% CI: 21.8-30.4%). Of those who were prescribed antibiotics, 79.6% (95% CI: 74.7-83.8%) received a first-line recommended agent and 58.9% (95% CI: 53.8-63.8%) received fully compliant therapy with respect to agent, dose, duration, and frequency. 19.4% (15.4-24.2%) of patients who were prescribed empiric cephalexin received an inappropriately high total daily dose. The proportion of patients receiving age-appropriate testing method was 52.2% (95% CI: 47.4-57.1). Febrile children were more likely to receive age-appropriate urine sample collection by catheterized sample (OR: 2.77 95% CI: 1.81-4.25) compared with afebrile children. Ultimately, 50.7% (95% CI: 40.4-49.6%) of patients discharged with a diagnosis of UTI and prescription for antibiotic met diagnostic criteria for UTI based on urinalysis and culture results. Of patients whose C&S mandated a change in therapy, 60.8% (95% CI: 55.8-65.7%) had their agent changed or discontinued. Conclusion Paediatric emergency medicine physicians frequently order inappropriate investigation and empiric treatment of UTI in young children. Discontinuation of empiric antibiotics in culture-negative children may be an impactful stewardship intervention in the PED.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Magdalena Jaworski, Hugo Cadorel, Annie Janvier, Marie-Ève Asselin
Abstract Background Oral health is often overlooked in the medical care for children with disabilities. While recommendations exist, these take little account of the daily reality of the main stakeholders: parents and dentists. Objectives Our goal was to explore the perspectives of parents and dentists regarding dental care for children with special needs, and contrast their lived experience with recommended best practices. Design/Methods 14 participants were recruited from a tertiary paediatric health centre to participate in semi-structured interviews: 9 parents of children with special needs (cerebral palsy, craniofacial anomalies, autism spectrum disorder) and 5 paediatric dentists. Interviews were conducted virtually in 2021. The participants were asked about oral health prevention, accessibility and treatment. The interviews were analyzed using qualitative methodology. Results Based on a thematic analysis of the content of the interviews, we identified several issues encountered by our participants in the context of the dental health of children with special needs. There were mainly issues of accessibility: ‘I work in the field and yet it was so difficult to find a dentist for my own child with disabilities’; financial barriers: ‘His dental needs are not covered because they are deemed aesthetic’; and geographical: ‘I am lucky, I have to drive 30 minutes to her appointments, but others need to drive for hours’. Parents also described difficulties in prevention: ‘I didn’t know how to care for his teeth; I used my own common sense’. The dentists emphasized the importance of communication: ‘I wish dentists were a part of the multidisciplinary healthcare team’. Also, sensitive questions regarding ethical issues, such as protective stabilization and general anesthesia were candidly answered by the majority of interviewees who accepted these practices as essential: ‘It [stabilization] is not easy to accept, but we know it is necessary’, and ‘I prefer getting the treatments done in one appointment [necessitating anaesthesia]’. These practices, in contrast, are deemed more problematic in the medical literature. Conclusion Dental care and prevention is essential since oral and dental problems can cause significant pain and distress. There is a significant gap between what “ought to be done” and the reality of families. Despite this, several practical recommendations emanated from the interviews that can be turned into actionable items in practice.
{"title":"74 “Dental Care for Children with Disability Is Not Considered Essential Care”: Perspectives of Parents and Dentists","authors":"Magdalena Jaworski, Hugo Cadorel, Annie Janvier, Marie-Ève Asselin","doi":"10.1093/pch/pxad055.074","DOIUrl":"https://doi.org/10.1093/pch/pxad055.074","url":null,"abstract":"Abstract Background Oral health is often overlooked in the medical care for children with disabilities. While recommendations exist, these take little account of the daily reality of the main stakeholders: parents and dentists. Objectives Our goal was to explore the perspectives of parents and dentists regarding dental care for children with special needs, and contrast their lived experience with recommended best practices. Design/Methods 14 participants were recruited from a tertiary paediatric health centre to participate in semi-structured interviews: 9 parents of children with special needs (cerebral palsy, craniofacial anomalies, autism spectrum disorder) and 5 paediatric dentists. Interviews were conducted virtually in 2021. The participants were asked about oral health prevention, accessibility and treatment. The interviews were analyzed using qualitative methodology. Results Based on a thematic analysis of the content of the interviews, we identified several issues encountered by our participants in the context of the dental health of children with special needs. There were mainly issues of accessibility: ‘I work in the field and yet it was so difficult to find a dentist for my own child with disabilities’; financial barriers: ‘His dental needs are not covered because they are deemed aesthetic’; and geographical: ‘I am lucky, I have to drive 30 minutes to her appointments, but others need to drive for hours’. Parents also described difficulties in prevention: ‘I didn’t know how to care for his teeth; I used my own common sense’. The dentists emphasized the importance of communication: ‘I wish dentists were a part of the multidisciplinary healthcare team’. Also, sensitive questions regarding ethical issues, such as protective stabilization and general anesthesia were candidly answered by the majority of interviewees who accepted these practices as essential: ‘It [stabilization] is not easy to accept, but we know it is necessary’, and ‘I prefer getting the treatments done in one appointment [necessitating anaesthesia]’. These practices, in contrast, are deemed more problematic in the medical literature. Conclusion Dental care and prevention is essential since oral and dental problems can cause significant pain and distress. There is a significant gap between what “ought to be done” and the reality of families. Despite this, several practical recommendations emanated from the interviews that can be turned into actionable items in practice.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background The COVID-19 pandemic has created considerable difficulties and barriers to accessing care for families of children with developmental disability (FCDD), particularly for families who are socially or economically marginalized. We have previously found that families have reported increased caregiver stress, difficulty navigating services and worsened social isolation. Building on these findings, a community-based intervention was co-created with community partners and families to improve social support, caregiver empowerment and access to services (see Figure 1, below), consisting of a ‘toolkit’ of resources with an accompanying workshop for caregivers and community service providers (CSPs), and a chat group community of support for caregivers. Objectives This study explored the feasibility of the co-designed intervention, examining the acceptability, implementation, and demand. Design/Methods This was a mixed-methods feasibility study, which incorporated quantitative and qualitative evaluation components, and received Research Ethics Board approval (SMH 20-127). Demand and implementation were assessed by measuring participant attendance in the workshops. Acceptability was assessed using post-workshop questionnaires to measure satisfaction and knowledge uptake, and further explored in semi-structured interviews, which were recorded, transcribed and analyzed using thematic analysis. Any caregiver, and CSPs who participated in any arm of the intervention, were invited to participate. Results Workshops were held 6 times (4 caregiver workshops, 2 staff workshops) in two community partner sites. A total of 55 participants (32 caregivers, 23 staff) participated. After receiving the toolkit and attending the workshop, both caregivers and CSPs reported that they felt more comfortable with navigating services, which was higher in CSPs (4.58/5, p<0.005). 100% of participants wanted additional iterations of the workshops with the toolkit. In the IDIs, both CSPs and caregivers reported that the toolkit was comprehensive and easy-to-use. Many caregivers reported using the toolkit immediately after the workshops to connect to new services. Among both CSPs and caregivers, it was found that the group chat was not commonly used but had the potential to be a helpful tool to share additional resources and discuss specific topics. Conclusion This community-based, co-created intervention was implemented successfully, with high acceptability and demand. Both CSPs and caregivers found the toolkit to be useful and have used it to successfully access services, while the group chat was less used. Our study demonstrates the critical importance of working alongside community to co-create interventions to best serve specific community needs.
{"title":"99 Feasibility of a Co-designed Community Intervention for Families of Children with Developmental Diagnoses","authors":"Puneet Parmar, Shazeen Suleman, Deidre Kelly-Adams, Chioma Nwebube","doi":"10.1093/pch/pxad055.099","DOIUrl":"https://doi.org/10.1093/pch/pxad055.099","url":null,"abstract":"Abstract Background The COVID-19 pandemic has created considerable difficulties and barriers to accessing care for families of children with developmental disability (FCDD), particularly for families who are socially or economically marginalized. We have previously found that families have reported increased caregiver stress, difficulty navigating services and worsened social isolation. Building on these findings, a community-based intervention was co-created with community partners and families to improve social support, caregiver empowerment and access to services (see Figure 1, below), consisting of a ‘toolkit’ of resources with an accompanying workshop for caregivers and community service providers (CSPs), and a chat group community of support for caregivers. Objectives This study explored the feasibility of the co-designed intervention, examining the acceptability, implementation, and demand. Design/Methods This was a mixed-methods feasibility study, which incorporated quantitative and qualitative evaluation components, and received Research Ethics Board approval (SMH 20-127). Demand and implementation were assessed by measuring participant attendance in the workshops. Acceptability was assessed using post-workshop questionnaires to measure satisfaction and knowledge uptake, and further explored in semi-structured interviews, which were recorded, transcribed and analyzed using thematic analysis. Any caregiver, and CSPs who participated in any arm of the intervention, were invited to participate. Results Workshops were held 6 times (4 caregiver workshops, 2 staff workshops) in two community partner sites. A total of 55 participants (32 caregivers, 23 staff) participated. After receiving the toolkit and attending the workshop, both caregivers and CSPs reported that they felt more comfortable with navigating services, which was higher in CSPs (4.58/5, p&lt;0.005). 100% of participants wanted additional iterations of the workshops with the toolkit. In the IDIs, both CSPs and caregivers reported that the toolkit was comprehensive and easy-to-use. Many caregivers reported using the toolkit immediately after the workshops to connect to new services. Among both CSPs and caregivers, it was found that the group chat was not commonly used but had the potential to be a helpful tool to share additional resources and discuss specific topics. Conclusion This community-based, co-created intervention was implemented successfully, with high acceptability and demand. Both CSPs and caregivers found the toolkit to be useful and have used it to successfully access services, while the group chat was less used. Our study demonstrates the critical importance of working alongside community to co-create interventions to best serve specific community needs.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachael Iseman, Lillian Lai, Marc Zucker, Johannes Roth, Elayna Jackson
Abstract Background In 2017, it was recognized that there was significant variation in the management and follow-up of Kawasaki disease (KD) at our institution, resulting in inefficient use of hospital resources and patient confusion. A multidisciplinary team from cardiology, rheumatology, emergency medicine, infectious diseases (ID), and general paediatrics created a standardized protocol distributed on October 10th, 2019. With the evolution of multisystem inflammatory syndrome in children associated with SARS-COVID 19 (MISC), we expanded our protocol in December 2021 to include a 1-week follow-up echocardiogram (echo). Objectives It has been 3 years since the KD standardized protocol was implemented. As a result, we seek to evaluate its effectiveness in improving patient care, specifically in the patients with normal coronary arteries. Design/Methods We reviewed the cardiology echo database to define patients who had an echo performed for KD (January 1, 2020-August 17, 2022). These patients were reviewed in the electronic hospital record to define those with a discharge diagnosis of KD. Results Of the 138 patients defined, 47 patients were discharged with KD; normal coronary arteries (N=38) were seen in 81% (38/47). Classic KD: 47% (18/38); incomplete KD: 53% (20/38); 13% (5/38) were diagnosed with both MISC and KD. Average age: 3.4 years (3 months to 9.5 years). We observed that rheumatology was consulted in 89% (34/38), cardiology in 100%, and ID in 50% (19/38). All patients were treated with low-dose acetylsalicylic acid (38/38), and the majority were treated with intravenous immunoglobulin, 92% (35/38). Some patients were treated with steroids, 26% (10/38). Average length of stay: 4.8 days (1-18 days). Twenty-one patients were seen from when we initiated performing a 1-week echo. In addition to the existing protocol, 24% (5/21) of cases missed having a 1-week follow-up echo because the cardiologist was not aware of the practice. Eighty-nine% (34/38) had their 6-week follow-up echo and follow-up in the post-hospitalization clinic (PHC) at the appropriate time. Patients were incorrectly scheduled to see the cardiologist in 13% (5/38) and the PHC in 3% (1/38) cases. Conclusion With the implementation of a standardized management and follow-up protocol for KD, our patients are now guaranteed follow-up with access to effective patient-centred care in a streamlined manner that targets appropriate use of resources. A satisfaction survey should be performed to inquire if families are pleased with this process.
{"title":"6 Evaluation of a Standardized Kawasaki Disease Protocol for Management and Follow-Up","authors":"Rachael Iseman, Lillian Lai, Marc Zucker, Johannes Roth, Elayna Jackson","doi":"10.1093/pch/pxad055.006","DOIUrl":"https://doi.org/10.1093/pch/pxad055.006","url":null,"abstract":"Abstract Background In 2017, it was recognized that there was significant variation in the management and follow-up of Kawasaki disease (KD) at our institution, resulting in inefficient use of hospital resources and patient confusion. A multidisciplinary team from cardiology, rheumatology, emergency medicine, infectious diseases (ID), and general paediatrics created a standardized protocol distributed on October 10th, 2019. With the evolution of multisystem inflammatory syndrome in children associated with SARS-COVID 19 (MISC), we expanded our protocol in December 2021 to include a 1-week follow-up echocardiogram (echo). Objectives It has been 3 years since the KD standardized protocol was implemented. As a result, we seek to evaluate its effectiveness in improving patient care, specifically in the patients with normal coronary arteries. Design/Methods We reviewed the cardiology echo database to define patients who had an echo performed for KD (January 1, 2020-August 17, 2022). These patients were reviewed in the electronic hospital record to define those with a discharge diagnosis of KD. Results Of the 138 patients defined, 47 patients were discharged with KD; normal coronary arteries (N=38) were seen in 81% (38/47). Classic KD: 47% (18/38); incomplete KD: 53% (20/38); 13% (5/38) were diagnosed with both MISC and KD. Average age: 3.4 years (3 months to 9.5 years). We observed that rheumatology was consulted in 89% (34/38), cardiology in 100%, and ID in 50% (19/38). All patients were treated with low-dose acetylsalicylic acid (38/38), and the majority were treated with intravenous immunoglobulin, 92% (35/38). Some patients were treated with steroids, 26% (10/38). Average length of stay: 4.8 days (1-18 days). Twenty-one patients were seen from when we initiated performing a 1-week echo. In addition to the existing protocol, 24% (5/21) of cases missed having a 1-week follow-up echo because the cardiologist was not aware of the practice. Eighty-nine% (34/38) had their 6-week follow-up echo and follow-up in the post-hospitalization clinic (PHC) at the appropriate time. Patients were incorrectly scheduled to see the cardiologist in 13% (5/38) and the PHC in 3% (1/38) cases. Conclusion With the implementation of a standardized management and follow-up protocol for KD, our patients are now guaranteed follow-up with access to effective patient-centred care in a streamlined manner that targets appropriate use of resources. A satisfaction survey should be performed to inquire if families are pleased with this process.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction/Background A growing body of research supports the efficacy of Dialectical Behavioural Therapy (DBT) for adolescents with various mental health diagnoses, but a traditional DBT program uses intensive resources (weekly individual and group therapy). To see whether a less intensive program could benefit certain participants, a complementary program called “DBT Lite” was designed and implemented at a large acute care Children’s Hospital. The group format (youth and parents together), therapeutic principals and coping skills taught were the same (based on “DBT Skills Manual for Adolescents”, Miller & Rathus, 2014), but DBT Lite involved only group therapy, and was offered over a shorter time frame (12 weeks vs. 19 weeks). Objectives The purpose of this study was to compare the effectiveness of “DBT Full” and “DBT Lite” on improving emotion regulation and family functioning/parental stress and decreasing emergency department (ED) visits and hospitalizations among adolescents age 13-17 with mental health diagnoses. Participants were not randomized; the treatment was selected according to severity of illness. We hypothesized that both treatment programs would show benefits but that “Full DBT” would result in greater improvements than “DBT Lite” due to its more comprehensive treatment model. Design/Methods Data was collected prospectively pre- and post-treatment from youth and parents participating in both programs over a 3-year period. The primary outcome measures were the DERS (Difficulties in Emotion Regulation Scale), the FACES-IV (Family Adaptability and Cohesion Scale, 4th Ed), and the PSS (Parental Stress Scale). Results were analyzed using paired-sample t-tests. We also examined ED and hospital admission data 6 months prior to starting the group and 6 months following completion of the group. Results In “Full DBT”, emotion regulation improved in both youth (n=9) and parents (n=12) post-treatment (DERS total score: youth p=0.02; parents p=0.01). Parents reported significant improvements on measures of parental stress (PSS p=0.002), and family functioning (FACES-IV family communication p=0.000, satisfaction p=0.008, and overall family functioning p=0.002). However, these improvements were not significant in youth measures. In “DBT Lite”, youth (n=16) and parents (n=17) did not report significant improvements in emotion regulation or family functioning, but did report decreases in parental stress (PSS p=0.005). Both groups resulted in measurable differences in acute care use: the percentage of patients with ED presentations 6 months pre- vs. 6 months post-group decreased from 70% to 27% for “Lite”, and 81% to 50% for “Full”. The percentage of patients requiring hospital admission decreased from 13% to 10% for “Lite”, and 56% to 28% for “Full”. Conclusion These results suggest that although “DBT Lite” may not have the same family functioning and emotion regulation benefits as its full-service counterpart, it can still reduce
{"title":"53 Adolescent Dialectical Behaviour Therapy: Levels of Care","authors":"Olivia MacLeod, Marjorie Robb, Anne Gillies","doi":"10.1093/pch/pxad055.053","DOIUrl":"https://doi.org/10.1093/pch/pxad055.053","url":null,"abstract":"Abstract Introduction/Background A growing body of research supports the efficacy of Dialectical Behavioural Therapy (DBT) for adolescents with various mental health diagnoses, but a traditional DBT program uses intensive resources (weekly individual and group therapy). To see whether a less intensive program could benefit certain participants, a complementary program called “DBT Lite” was designed and implemented at a large acute care Children’s Hospital. The group format (youth and parents together), therapeutic principals and coping skills taught were the same (based on “DBT Skills Manual for Adolescents”, Miller & Rathus, 2014), but DBT Lite involved only group therapy, and was offered over a shorter time frame (12 weeks vs. 19 weeks). Objectives The purpose of this study was to compare the effectiveness of “DBT Full” and “DBT Lite” on improving emotion regulation and family functioning/parental stress and decreasing emergency department (ED) visits and hospitalizations among adolescents age 13-17 with mental health diagnoses. Participants were not randomized; the treatment was selected according to severity of illness. We hypothesized that both treatment programs would show benefits but that “Full DBT” would result in greater improvements than “DBT Lite” due to its more comprehensive treatment model. Design/Methods Data was collected prospectively pre- and post-treatment from youth and parents participating in both programs over a 3-year period. The primary outcome measures were the DERS (Difficulties in Emotion Regulation Scale), the FACES-IV (Family Adaptability and Cohesion Scale, 4th Ed), and the PSS (Parental Stress Scale). Results were analyzed using paired-sample t-tests. We also examined ED and hospital admission data 6 months prior to starting the group and 6 months following completion of the group. Results In “Full DBT”, emotion regulation improved in both youth (n=9) and parents (n=12) post-treatment (DERS total score: youth p=0.02; parents p=0.01). Parents reported significant improvements on measures of parental stress (PSS p=0.002), and family functioning (FACES-IV family communication p=0.000, satisfaction p=0.008, and overall family functioning p=0.002). However, these improvements were not significant in youth measures. In “DBT Lite”, youth (n=16) and parents (n=17) did not report significant improvements in emotion regulation or family functioning, but did report decreases in parental stress (PSS p=0.005). Both groups resulted in measurable differences in acute care use: the percentage of patients with ED presentations 6 months pre- vs. 6 months post-group decreased from 70% to 27% for “Lite”, and 81% to 50% for “Full”. The percentage of patients requiring hospital admission decreased from 13% to 10% for “Lite”, and 56% to 28% for “Full”. Conclusion These results suggest that although “DBT Lite” may not have the same family functioning and emotion regulation benefits as its full-service counterpart, it can still reduce","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chioma Newbube, Puneet Parmar, Shazeen Suleman, Martha Taylor
Abstract Background In 2022 alone, 27,000 refugee claimants entered Canada, seeking protection. Although refugee claimants are ineligible for provincial health insurance programs, the Interim Federal Health Program (IFHP) provides coverage for basic medical care and supplemental services. However, previous studies have shown that only 24% of paediatricians are registered for IFHP, suggesting limited access for refugee claimant youth (RCYs), who are already at increased risk of poor health outcomes. It is important to understand the perspectives and needs of RCYs and their caregivers to develop interventions to improve their access to care, but to date, no study has examined their experiences directly. Objectives This study aims to explore how RCY, their caregivers, service providers and health care providers understand and utilize the healthcare system after arrival in Canada. Design/Methods This was a qualitative study that was rooted in community-based participatory action methodology. In-depth interviews (IDIs) were conducted with RCYs (age 10-18), their caregivers, community service providers (ie. settlement workers) and health care providers (HCPs) that worked with RCYs in a large urban Canadian city in English, and with an interpreter, recorded and transcribed. Transcripts were coded using inductive coding methods, and analyzed within and across stakeholder groups using thematic analysis. Results A total of 27 IDIs were conducted (8 HCPs, 9 community service providers, 5 caregivers, and 5 RCYs). Youth and their caregivers had little to no understanding of how the healthcare system operated in Canada, including how IFHP provided coverage. Most explained that their limited knowledge about the healthcare system was provided informally through social contacts, or their community service providers, who in turn expressed limited understanding of IFHP coverage and difficulty finding IFHP registered providers. Although healthcare providers similarly found IFHP difficult to navigate, they did not appreciate how little RCYs and their families understood the healthcare system, nor the difficulties placed on community service providers. RCYs stated that a youth-oriented, multi-lingual resource that explained how to access care in Canada would be a useful tool to help them feel empowered to advocate for themselves and their families. Conclusion Although policies exist to provide coverage for medical care for RCYs, there are many barriers that prevent them from accessing care, including limited knowledge of the system and few navigational supports. Our findings suggest that working with RCY themselves to co-develop a youth-centred approach to understanding the healthcare system may increase youth empowerment and access to care.
{"title":"100 Exploring the Experiences of Refugee Claimant Youth and their Caregivers with Navigating Healthcare in Canada","authors":"Chioma Newbube, Puneet Parmar, Shazeen Suleman, Martha Taylor","doi":"10.1093/pch/pxad055.100","DOIUrl":"https://doi.org/10.1093/pch/pxad055.100","url":null,"abstract":"Abstract Background In 2022 alone, 27,000 refugee claimants entered Canada, seeking protection. Although refugee claimants are ineligible for provincial health insurance programs, the Interim Federal Health Program (IFHP) provides coverage for basic medical care and supplemental services. However, previous studies have shown that only 24% of paediatricians are registered for IFHP, suggesting limited access for refugee claimant youth (RCYs), who are already at increased risk of poor health outcomes. It is important to understand the perspectives and needs of RCYs and their caregivers to develop interventions to improve their access to care, but to date, no study has examined their experiences directly. Objectives This study aims to explore how RCY, their caregivers, service providers and health care providers understand and utilize the healthcare system after arrival in Canada. Design/Methods This was a qualitative study that was rooted in community-based participatory action methodology. In-depth interviews (IDIs) were conducted with RCYs (age 10-18), their caregivers, community service providers (ie. settlement workers) and health care providers (HCPs) that worked with RCYs in a large urban Canadian city in English, and with an interpreter, recorded and transcribed. Transcripts were coded using inductive coding methods, and analyzed within and across stakeholder groups using thematic analysis. Results A total of 27 IDIs were conducted (8 HCPs, 9 community service providers, 5 caregivers, and 5 RCYs). Youth and their caregivers had little to no understanding of how the healthcare system operated in Canada, including how IFHP provided coverage. Most explained that their limited knowledge about the healthcare system was provided informally through social contacts, or their community service providers, who in turn expressed limited understanding of IFHP coverage and difficulty finding IFHP registered providers. Although healthcare providers similarly found IFHP difficult to navigate, they did not appreciate how little RCYs and their families understood the healthcare system, nor the difficulties placed on community service providers. RCYs stated that a youth-oriented, multi-lingual resource that explained how to access care in Canada would be a useful tool to help them feel empowered to advocate for themselves and their families. Conclusion Although policies exist to provide coverage for medical care for RCYs, there are many barriers that prevent them from accessing care, including limited knowledge of the system and few navigational supports. Our findings suggest that working with RCY themselves to co-develop a youth-centred approach to understanding the healthcare system may increase youth empowerment and access to care.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction/Background Although rare, in-hospital paediatric mortality occurs at a rate of 12.66 per 1000 admissions. Delayed recognition of clinical deterioration is a modifiable factor in such adverse events. In paediatric patients, subtle changes in vital signs often precede acute deterioration and provide an opportunity for early intervention and prevention of further deterioration. Based on this rationale, rapid response systems (RRS), which include a critical care response team (CCRT) and a Paediatric Early Warning Score (PEWS), have been established to facilitate the detection of clinical deterioration and mobilize resources for timely treatment. There is evidence that RRS can significantly decrease inpatient clinical deterioration events and PICU utilization. Objectives At our institution, serious patient safety events identified system failures in recognition, communication, and escalation of care in response to clinical deterioration. The root cause analysis led to a quality improvement and patient safety initiative to implement an RRS at our tertiary paediatric care centre. Design/Methods Process implementation of this pilot project required consultations with key stakeholders and designation of unit champions to mobilize resources and promote buy-in. Based on other successful implementation strategies, we adopted the Modified Brighton PEWS, defined a response algorithm, created bedside tools, constructed an interdisciplinary CCRT, and organized simulation activities to implement the new process. We used the Plan-Do-Study-Act method to carry out change based on weekly feedback from frontline workers. To assess the feasibility and acceptability of this initiative, all CCRT activations during the pilot phase were reviewed and a survey was distributed pre- and post-implementation. The number of code blues and mortality data will also be measured. Results The pilot period spanned June to September 2022 on our medical inpatient unit. Average response time to CCRT activation was 12 minutes (IQR 7-13.5), a median of three therapeutic interventions were required per activation, and 33% of activations resulted in PICU admissions. Among the 27 post–implementation survey respondents, 87% identified CCRT as a useful addition to optimize care and address patient safety concerns. Qualitatively, it has created a shared safety culture and empowered junior members of healthcare teams to escalate care. Conclusion This quality improvement initiative pilot study has demonstrated feasibility and acceptability of RRS implementation with a positive impact on patient safety culture and earlier detection and intervention for deteriorating patients. Further prospective comparative clinical benefits and cost-benefit analyses are needed to support hospital-wide implementation.
{"title":"42 Enacting Meaningful Change in the Face of Adversity – Use of a Sentinel Event to Pilot the Creation of a Rapid Response System in a Tertiary Paediatric Care Centre","authors":"Mariam Naguib, Hajare Iraqi, Anab Rebecca Lehr, Catherine Rich, Joshua Feder, Biagina-Carla Farnesi","doi":"10.1093/pch/pxad055.042","DOIUrl":"https://doi.org/10.1093/pch/pxad055.042","url":null,"abstract":"Abstract Introduction/Background Although rare, in-hospital paediatric mortality occurs at a rate of 12.66 per 1000 admissions. Delayed recognition of clinical deterioration is a modifiable factor in such adverse events. In paediatric patients, subtle changes in vital signs often precede acute deterioration and provide an opportunity for early intervention and prevention of further deterioration. Based on this rationale, rapid response systems (RRS), which include a critical care response team (CCRT) and a Paediatric Early Warning Score (PEWS), have been established to facilitate the detection of clinical deterioration and mobilize resources for timely treatment. There is evidence that RRS can significantly decrease inpatient clinical deterioration events and PICU utilization. Objectives At our institution, serious patient safety events identified system failures in recognition, communication, and escalation of care in response to clinical deterioration. The root cause analysis led to a quality improvement and patient safety initiative to implement an RRS at our tertiary paediatric care centre. Design/Methods Process implementation of this pilot project required consultations with key stakeholders and designation of unit champions to mobilize resources and promote buy-in. Based on other successful implementation strategies, we adopted the Modified Brighton PEWS, defined a response algorithm, created bedside tools, constructed an interdisciplinary CCRT, and organized simulation activities to implement the new process. We used the Plan-Do-Study-Act method to carry out change based on weekly feedback from frontline workers. To assess the feasibility and acceptability of this initiative, all CCRT activations during the pilot phase were reviewed and a survey was distributed pre- and post-implementation. The number of code blues and mortality data will also be measured. Results The pilot period spanned June to September 2022 on our medical inpatient unit. Average response time to CCRT activation was 12 minutes (IQR 7-13.5), a median of three therapeutic interventions were required per activation, and 33% of activations resulted in PICU admissions. Among the 27 post–implementation survey respondents, 87% identified CCRT as a useful addition to optimize care and address patient safety concerns. Qualitatively, it has created a shared safety culture and empowered junior members of healthcare teams to escalate care. Conclusion This quality improvement initiative pilot study has demonstrated feasibility and acceptability of RRS implementation with a positive impact on patient safety culture and earlier detection and intervention for deteriorating patients. Further prospective comparative clinical benefits and cost-benefit analyses are needed to support hospital-wide implementation.","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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