Patenaude A.F.,Dana-Farber Cancer Institute |
Pelletier W.,Alberta Childrens Hospital |
Bingen K.,Medical College of Wisconsin
Pediatric Blood and Cancer | Year: 2015
As part of a larger effort to create standards for psychosocial care of children with cancer, we document consensus and evidence-based data on interprofessional communication, documentation, and training for professionals providing psycho-oncology services. Six databases were searched. Sixty-five articles and six guidelines and consensus-based documents were identified; 35 met inclusion criteria. Data support strong recommendations for standards of care in communication/collaboration, documentation of patient information, and training in pediatric psycho-oncology. These are areas where extensive research is unlikely to be conducted; however, professional expectations and qualifications may be further clarified and strengthened with time. Pediatr Blood Cancer. © 2015 Wiley Periodicals, Inc.
Oliveira C.,Hospital for Sick Children |
Nasr A.,Hospital for Sick Children |
Brindle M.,Alberta Childrens Hospital |
Wales P.W.,Hospital for Sick Children
Pediatrics | Year: 2012
OBJECTIVE: Patients with pediatric intestinal failure (IF) depend on parenteral nutrition for growth and survival, but are at risk for complications, such as catheter-related bloodstream infections (CRBSIs). CRBSI prevention is crucial, as sepsis is an important cause of IF-associated liver disease and mortality. We aim to estimate the pooled effectiveness and safety of ethanol locks (ELs) in comparison with heparin locks (HLs) with regard to CRBSI rate and catheter replacements for pediatric IF patients with chronic parenteral nutrition dependence. METHODS: A systematic review without language restriction was performed on Medline (1948-2010), Embase (1980-2010), and conference programs and trial registries up to December 2010. Search terms included "Catheter-Related Infections," "Catheter," "Catheters, Indwelling," "alcohol," "ethanol," and "lock." Two authors identified 4 retrospective studies for the pediatric IF population. Double, independent data extraction using predefined data fields and risk of bias assessment (Newcastle-Ottawa scale) was performed. RESULTS: In comparison with HLs, ELs reduced the CRBSI-rate per 1000 catheter days by 7.67 events and catheter replacements by 5.07. EL therapy decreased the CRBSI rate by 81% and replacements by 72%. One hundred eight to 150 catheter days of EL exposure were necessary to prevent 1 CRBSI and 122 to 689 days of exposure avoided 1 catheter replacement. Adverse events were rare and included thrombotic events. CONCLUSIONS: In pediatric patients with IF, EL is a more effective alternative to HL. Adverse events include thrombotic events. Copyright © 2012 by the American Academy of Pediatrics.
Twilt M.,Birmingham Childrens Hospital |
Benseler S.,Alberta Childrens Hospital
Current Opinion in Rheumatology | Year: 2014
PURPOSE OF REVIEW: The purpose of this review is to discuss the most recent published literature in childhood antineutrophil cytoplasmic antibodies (ANCA) associated vasculitides and to identify the important issues arisen in the adult literature. This review will discuss the literature on new treatment regimens and outcome measurements. RECENT FINDINGS: Antineutrophil cytoplasmic antibodies are a hallmark of ANCA-associated vasculitides and are likely to be integral to the pathogenesis and have recently become a therapeutic target. In paediatrics, international collaborations have led to the development of childhood classification criteria, advanced understanding of the clinical phenotypes of childhood ANCA-associated vasculitides and improved our ability to capture disease severity, activity and damage. Treatment safety and efficacy data are mainly derived from adult studies and there is a lack of specific paediatric data. There are small case series on the efficacy of adult regimens in paediatric patients. SUMMARY: International multicentre studies are necessary for the evaluation of efficacy and safety of adult-derived treatment regimens in childhood ANCA-associated vasculitides. Specific childhood outcome measurements are recently developed for research purposes and enhance clinical care. © 2013 Wolters Kluwer Health Lippincott Williams & Wilkins.
Kirton A.,Alberta Childrens Hospital
Pediatric Neurology | Year: 2013
Perinatal stroke is presented as the ideal human model of developmental neuroplasticity. The precise timing, mechanisms, and locations of specific perinatal stroke diseases provide common examples of well defined, focal, perinatal brain injuries. Motor disability (hemiparetic cerebral palsy) constitutes the primary adverse outcome and the focus of models explaining how motor systems develop in health and after early injury. Combining basic science animal work with human applied technology (functional magnetic resonance imaging, diffusion tensor imaging, and transcranial magnetic stimulation), a model of plastic motor development after perinatal stroke is presented. Potential central therapeutic targets are revealed. The means to measure and modulate these targets, including evidence-based rehabilitation therapies and noninvasive brain stimulation, are suggested. Implications for clinical trials and future directions are discussed. © 2013 Elsevier Inc. All rights reserved.
Eppich W.,Ann And Robert H Lurie Childrens Hospital Of Chicago |
Cheng A.,Alberta Childrens Hospital
Simulation in Healthcare | Year: 2015
We describe an integrated conceptual framework for a blended approach to debriefing called PEARLS [Promoting Excellence And Reflective Learning in Simulation]. We provide a rationale for scripted debriefing and introduce a PEARLS debriefing tool designed to facilitate implementation of the new framework. The PEARLS framework integrates 3 common educational strategies used during debriefing, namely, (1) learner self-assessment, (2) facilitating focused discussion, and (3) providing information in the form of directive feedback and/or teaching. The PEARLS debriefing tool incorporates scripted language to guide the debriefing, depending on the strategy chosen. The PEARLS framework and debriefing script fill a need for many health care educators learning to facilitate debriefings in simulation-based education. The PEARLS offers a structured framework adaptable for debriefing simulations with a variety in goals, including clinical decision making, improving technical skills, teamwork training, and interprofessional collaboration. © 2015 Society for Simulation in Healthcare.
Rabi Y.,University of Calgary |
Singhal N.,University of Calgary |
Nettel-Aguirre A.,Alberta Childrens Hospital
Pediatrics | Year: 2011
OBJECTIVE: We conducted a blinded, prospective, randomized control trial to determine which oxygen-titration strategy was most effective at achieving and maintaining oxygen saturations of 85% to 92% during delivery-room resuscitation. METHODS: Infants born at 32 weeks' gestation or less were resuscitated either with a static concentration of 100% oxygen (high-oxygen group) or using an oxygen-titration strategy starting from a concentration of 100% (moderate-oxygen group), or 21% oxygen (low-oxygen group). In the moderate- and low-oxygen groups, the oxygen concentration was adjusted by 20% every 15 seconds to reach a target oxygen saturation range of 85% to 92%. Treatment failure was defined as a heart rate slower than 100 beats per minute for longer than 30 seconds. RESULTS: The moderate-oxygen group spent a greater proportion of time in the target oxygen saturation range (mean: 0.21 [95% confidence interval: 0.16-0.26]) than the high-oxygen group (mean: 0.11 [95% confidence interval: 0.09-0.14]). Infants in the low-oxygen group were 8 times more likely to meet the criteria for treatment failure than those in the high-oxygen group (24% vs 3%; P=.022). The 3 groups did not differ significantly in the time to reach the target oxygen saturation range. CONCLUSIONS: Titrating from an initial oxygen concentration of 100% was more effective than giving a static concentration of 100% oxygen in maintaining preterm infants in a target oxygen saturation range. Initiating resuscitation with 21% oxygen resulted in a high treatmentfailure rate. Copyright © 2011 by the American Academy of Pediatrics.
Guilfoyle F.J.,Alberta Childrens Hospital
CJEM : Canadian journal of emergency medical care = JCMU : journal canadien de soins médicaux d'urgence | Year: 2011
To describe the frequency and proportion of successful resuscitation interventions in a pediatric emergency department (PED). This was a retrospective chart review of children at the BC Children's Hospital (BCCH) PED who were admitted to the BCCH pediatric intensive care unit (PICU) in 2004 and 2005. Demographic data, diagnosis, and resuscitation interventions in the PED and within the first 24 hours of PICU admission were recorded. The training of the operator and the number of attempts needed were also recorded. There were 75,133 PED visits; 304 of 329 (92.4%) who met inclusion criteria were reviewed. Diagnoses included respiratory distress (n=115, 35%), trauma (n=50, 15%), sepsis (n=36, 11%), seizures (n=37, 11%), and cardiac disease (n=22, 7%). Ninety-nine patients required intubation. Intubations in the PED were performed by residents (20%), pediatric emergency medicine (PEM) fellows (15%), PEM attending staff (29%), and PICU fellows (12%); 81% of these were successful on the first attempt. In the PED, seven central lines were placed, seven intraosseous needles were inserted, 15 patients required inotropes, and 9 patients required chest compressions. Critical illness in our emergency department is a rare event; hence, opportunities to resuscitate, secure airways, and place central venous catheters are limited. Additional training, close working relationships between the PED and the PICU teams, and resuscitation protocols for early PICU involvement may be needed.
Mineyko A.,Alberta Childrens Hospital |
Kirton A.,Alberta Childrens Hospital
Pediatric Neurology | Year: 2013
Arteriopathy is the leading cause of childhood arterial ischemic stroke, but its mechanisms are poorly understood. This review explores the possible role of inflammatory mechanisms and evidence for inflammatory pathophysiology in specific pediatric cerebral arteriopathies. Pathologically proven small-vessel central nervous system vasculitis provides a definitive inflammatory model where available treatments are likely improving outcomes. In contrast, a common large-vessel arteriopathy presents many features suggestive of inflammation, but definitive proof remains elusive. Recent advances and future research directions, including biomarker, neuroimaging, and pathologic approaches and how they might address these important clinical questions, are discussed. © 2013 Elsevier Inc. All rights reserved.
Anselmo M.,Alberta Childrens Hospital
Pediatric Drugs | Year: 2011
The treatment of children with asthma has historically relied upon expert opinion using data extrapolated from adult studies. Over the past few years, landmark studies have been completed providing healthcare professionals with evidence on which a reasonable approach can be made for children suffering from this common and serious disease. Asthmatic phenotype in children, unlike adults, tends to differ according to age, which must be taken into account as well as triggers, severity, and level of control. The care of the child with asthma is complex, but accumulating data have demonstrated that we are on the right path for optimizing control while reducing the burden of side effects. The newest Global Initiative for Asthma (GINA) guidelines, as well as recent updates from the landmark CAMP (Childhood Asthma Management Program) study and information from the PACT (Pediatric Asthma Control Trial) and budesonide/formoterol controller and reliever studies, along with recent comparisons of higher dose inhaled corticosteroids (ICS), and ICS/long-acting β 2- adrenoceptor agonist (LABA) combination and leukotriene receptor antagonist (LTRA) therapies in children have clarified a few of the big questions in pediatric asthma. For children with asthma aged 5 years and older, the CAMP trial demonstrated that regular use of ICS reduces the frequency of symptoms; however, height was adversely affected and there is no evidence for altering the natural history of asthma. In patients aged 6 years and over whose asthma is uncontrolled on ICS alone, combination therapy with ICS and a LABA has been recently compared with the use of higher dose ICS and the addition of an LTRA in pediatric patients. The addition of a LABA statistically will be of most benefit; however, some children will have optimal control with doubling the baseline dose of ICS or addition of an LTRA. Use of budesonide/formoterol as a controller and reliever therapy extends the time to first exacerbation versus contemporary use of this medication in patients aged 4 years and older. Ciclesonide, a newer ICS, has demonstrated acceptable efficacy but has the added benefit of not affecting growth. Certainly, with mounting evidence, the care-map in pediatric asthma control is becoming clearer. © 2011 Adis Data Information BV. All rights reserved.
Brooks B.L.,Alberta Childrens Hospital |
Brooks B.L.,University of Calgary
Psychological Assessment | Year: 2010
Low scores across a battery of tests are common in healthy people and vary by demographic characteristics. The purpose of the present article was to present the base rates of low scores for the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV; D. Wechsler, 2003). Participants included 2,200 children and adolescents between 6 and 16 years of age from the WISC-IV U.S. standardization sample. Measures considered in the base rates analyses included the 10 core subtests and the 4 index scores. Analyses were conducted for the entire standardization sample as well as stratified by different classifications of intelligence and different years of parental education. In the total sample, it is uncommon to have 6 or more subtest scores or 2 or more Index scores ≤ 9th percentile. The prevalence of low scores typically increased with lesser intelligence and fewer years of parental education (e.g., children with below-average intelligence were 75 times more likely than children with above-intelligence to have at least one impaired subtest score). Consistent with existing studies of the base rates of low scores, some low scores on the WISC-IV were common in children and adolescents, and the frequency was related to a child's level of intelligence and parental education. © 2010 American Psychological Association.