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Nadel H.R.,British Columbia Childrens Hospital
Seminars in Nuclear Medicine | Year: 2010

Bone scintigraphy is a sensitive tool to evaluate the musculoskeletal system in children. Hybrid imaging using computed tomography (CT) in combination with conventional bone scan and single photon emission computed tomography improves specificity and diagnostic accuracy. It also improves laboratory efficiency and may save the patient an additional visit to the hospital for a separate cross-sectional imaging study. We have found this technique to be particularly helpful in localizing a cause for pain in children who are nonverbal and to better delineate small bone and soft-tissue lesions that can occur with diagnoses of trauma, infection, and tumor. Special attention to technique of positioning the patient for potential CT examination is an adaptation that must be made by the technologist. Because of radiation concerns of the additional CT, obviously these examinations should be tailored to the individual child and be performed for limited sites directed to the abnormality observed on the associated single photon emission computed tomography examination or directed by the appropriate history. © 2010 Elsevier Inc. All rights reserved.


Lyons C.J.,British Columbia Childrens Hospital
Pediatric endocrinology reviews : PER | Year: 2010

Strabismus is a disabling aspect of thyroid orbitopathy. Whilst horizontal deviations can be corrected relatively simply, the propensity for inferior rectus involvement makes vertical deviations common. Because the deviations are usually incomitant, prisms have a limited role in management, and surgery is frequently indicated after stability has been documented for at least 6 months. Careful pre-operative discussion of the goals and limitations of strabismus surgery is of paramount importance since a degree of limitation remains postoperatively, even after two or even three surgeries. Nevertheless, with careful planning and duction-testing, a satisfactory central field of binocular single vision can be achieved in the primary position and downgaze, returning this group of patients to a comfortable binocular status for the majority of their day-to-day life.


Arneja J.S.,British Columbia Childrens Hospital | Mulliken J.B.,British Columbia Childrens Hospital
Plastic and Reconstructive Surgery | Year: 2010

Background: Periocular hemangiomas can induce irreversible amblyopia by multiple mechanisms: visual deprivation, refractive error (astigmatism and/or anisometropia), or strabismus. There is a subset of complicated periocular hemangiomas most effectively managed by resection. Methods: The authors reviewed all patients from 1999 to 2008 with a periocular hemangioma that was either completely resected or debulked; whenever necessary, the levator apparatus was reinserted. Infants were included in the study if they had complete preoperative and postoperative ophthalmic assessments and there was more than a 6-month follow-up interval. Results: Thirty-three children were treated with a mean operative age of 6.2 months and a mean follow-up interval of 48.2 months. The majority of hemangiomas were well-localized and caused corneal deformation with astigmatism or blepharoptosis. Intralesional or oral corticosteroid administration was attempted in almost one-half of patients. Postoperatively, the degree of astigmatism was statistically improved: from 3.0 diopters to 1.11 diopters (p < 0.001). When resection was performed in infants younger than 3 months (19 patients), astigmatism was less severe preoperatively and the correction was slightly greater postoperatively (from 2.76 diopters to 0.80 diopters). Resection performed after 3 months (14 patients) of age also resulted in improvement of astigmatism (from 3.39 diopters to 1.38 diopters). Reinsertion of the levator expansion was required in 34 percent of patients. Conclusions: The authors advocate early resection of a well-localized periocular hemangioma to prevent potentially irreversible amblyopia caused by either corneal deformation or blepharoptosis. The longer a complicated periocular hemangioma is observed, the greater the astigmatism and the less amenable it will be to correction following tumor removal. © 2009 by the American Society of Plastic Surgeons.


Houghton K.,British Columbia Childrens Hospital
The Physician and sportsmedicine | Year: 2012

Arthritis in childhood can be associated with low levels of physical activity and poor physical fitness. Children with arthritis may have decreased aerobic and anaerobic fitness, muscle weakness, low bone mass, and low bone strength. Suboptimal physical activity and exercise capacity may contribute to further deconditioning and disability, placing children with arthritis at risk for poor health outcomes. Recent studies suggest that exercise therapy is safe and does not worsen arthritis. Exercise therapy may improve function, quality of life, and physical fitness. However, little is known about the exercise prescription that is most effective to improve clinical outcomes in children with arthritis. This article reviews the current literature on physical activity, physical fitness, and exercise therapy in children with juvenile idiopathic arthritis.


Mortenson P.,British Columbia Childrens Hospital
Journal of Head Trauma Rehabilitation | Year: 2016

OBJECTIVES:: To investigate the effectiveness and feasibility of early intervention telephone counseling with parents in limiting postconcussion symptoms and impacts on children and youth. SETTING:: Recruitment occurred postdischarge from one pediatric emergency department. PARTICIPANTS:: Sixty-six parents of children aged 5 to 16 years with a diagnosis of a concussion injury. DESIGN:: A pilot, randomized controlled study compared the efficacy of telephone counseling (reviewing symptom management and return to activity with parents at 1 week and 1 month postinjury) with usual care (no formalized follow-up). MAIN MEASURES:: The Post-Concussion Symptom Inventory and the Family Burden of Injury Interview administered with parents by a blinded therapist at 3 months postinjury. RESULTS:: No significant difference between the groups at 3 months postinjury in postconcussion symptoms (P = .67) and family stress (P = .647). CONCLUSION:: The findings suggest that the early counseling intervention strategy trialed herein may not be effective for children and youth who experience significant postconcussion symptoms. Further research is needed to determine whether more intensive and integrated care would better serve children. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Carroll M.W.,British Columbia Childrens Hospital | Jacobson K.,British Columbia Childrens Hospital | Jacobson K.,University of British Columbia
Pediatric Drugs | Year: 2012

Gastroesophageal reflux (GER) is a common presenting complaint in children and adults, and is a frequent reason for physician consultation. GER disease (GERD), whilst benign in the majority of cases, is frequently a chronic condition that has been shown to result in significantly reduced quality of life in children and adolescents. Furthermore, there is emerging evidence that the prevalence of GERD is rising and may have links to adult obesity and other morbidities. Consequently, accurate diagnosis, appropriate management strategies, and timely referral to specialist services are important principles in the effective management of GERD. Acid-suppressive drugs are effective therapies but are one of the most costly classes of drugs prescribed. Therefore, not only is an accurate diagnosis important to the patient, but it is also of significant interest from a public health and resource utilization standpoint. © 2012 Adis Data Information BV. All rights reserved.


Ou C.,British Columbia Childrens Hospital
Canadian journal of neuroscience nursing | Year: 2010

Children with cerebral palsy may experience spasticity, which may negatively impact their quality of life. One proven treatment for such spasticity is selective dorsal rhizotomy (SDR), whereby a partial sectioning of the dorsal roots from L2 to S1 is performed. SDR can be performed where the nerve root exits the intervertebral foramina via multi-level laminectomies, or at the level of the conus via a single-level laminectomy. At British Columbia Children's Hospital (BCCH), SDRs were performed via multi-level laminectomies until 2005, when the single-level technique was adopted. The single-level procedure is technically more challenging and takes longer, but requires a smaller incision and involves less muscle dissection. Functional outcomes at one-year follow-up are similar for the two methods of surgery. It was hypothesized that post-operative pain would be less, mobilization faster and hospital stay shorter using the single-level technique. Using a retrospective case series analysis, we compared nine patients who had had single-level SDR to 18 matched controls who had undergone SDR using the multi-level technique. There were no significant differences in post-operative pain, duration of opioid infusion, or time to mobilization. Length of hospital stay was significantly decreased after the single level procedure: 3.4 versus 5.2 days (p = 0.01).


Houghton K.,British Columbia Childrens Hospital
Physician and Sportsmedicine | Year: 2012

Arthritis in childhood can be associated with low levels of physical activity and poor physical fitness. Children with arthritis may have decreased aerobic and anaerobic fitness, muscle weakness, low bone mass, and low bone strength. Suboptimal physical activity and exercise capacity may contribute to further deconditioning and disability, placing children with arthritis at risk for poor health outcomes. Recent studies suggest that exercise therapy is safe and does not worsen arthritis. Exercise therapy may improve function, quality of life, and physical fitness. However, little is known about the exercise prescription that is most effective to improve clinical outcomes in children with arthritis. This article reviews the current literature on physical activity, physical fitness, and exercise therapy in children with juvenile idiopathic arthritis.


Slobogean G.P.,University of British Columbia | Slobogean B.L.,British Columbia Childrens Hospital
Injury | Year: 2011

The increasing shift towards patient-centred healthcare has lead to an emergence of patient-reported outcome instruments to quantify functional outcomes in orthopaedic patients. Unfortunately, selecting an instrument for use in a shoulder trauma population is often problematic because most shoulder instruments were initially designed for use with chronic shoulder pathology patients. To ensure an instrument is valid, reliable, and sensitive to clinical changes, it is important to obtain psychometric evidence of its use in the target population. Four commonly used shoulder outcome instruments are reviewed in this paper: American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES); Constant-Murley shoulder score (CMS); Disabilities of Arm, Shoulder, and Hand (DASH); Oxford Shoulder Score (OSS). Each instrument was reviewed for floor or ceiling effects, validity, reliability, responsiveness, and interpretability. Additionally, evidence of each instrument's psychometric properties was sought in shoulder fracture populations. Based on the current literature, each instrument has limited amounts of evidence to support their use in shoulder trauma populations. Overall, psychometric evaluations in isolated shoulder fracture populations remain scarce, and clinicians must remember that an instrument's properties are defined for the population tested and not the instrument. Therefore, caution must always be exercised when using an instrument that has not been fully evaluated in trauma populations. © 2010 Elsevier Ltd.


Limbos M.M.,British Columbia Childrens Hospital | Joyce D.P.,University of British Columbia
Journal of Developmental and Behavioral Pediatrics | Year: 2011

Objectives: This study investigated the sensitivity and specificity of two brief, parent-completed developmental screening measures-the Ages and Stages Questionnaire (ASQ) and the Parents' Evaluation of Developmental Status (PEDS)-in children presenting to their primary care providers. Method: A sample of 334 children aged 12 to 60 months was recruited. Parents completed the PEDS and the ASQ in their home or the primary care clinic of one of the investigators. The presence of 1 predictive concerns or abnormal domains was considered a positive screen. All children underwent evaluation (administered by a psychologist) with the following criterion measures: the Bayley Scales of Infant Development-Third Edition or the Wechsler Preschool and Primary Scale of Intelligence-Third Edition, the Preschool Language Scale-Fourth Edition, and the Vineland Adaptive Behavior Scales-Second Edition. Results: The mean age of children was 32.3 months. Developmental delay was identified in 34 children (10%). The PEDS had moderate sensitivity (74%) but low specificity (64%); comparatively, the ASQ had significantly higher sensitivity (82%) and specificity (78%). The ASQ had moderate sensitivity and specificity across age subgroups, whereas the PEDS had either low sensitivity or specificity in each of the age subgroups, except for the ≤30 month group, where there was moderate sensitivity (78%) and specificity (75%). Using 2 predictive concerns on the PEDS or 2 abnormal domains on the ASQ significantly improved specificity of both tests (89% and 94%, respectively) but resulted in very low sensitivity (41% and 47%, respectively). Conclusions: These findings support the guidelines of the American Academy of Pediatrics, demonstrating that both the ASQ and, to a lesser extent, the PEDS have reasonable test characteristics for developmental screening in primary care settings. Although the ASQ seems to have higher sensitivity and specificity across a variety of age groups, the choice of which measure to use should be determined by the practice setting, population served, and preference of the physician. © 2011 Lippincott Williams & Wilkins.

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