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Thomas M.,Childrens Hospital of Eastern Ontario
Dynamics (Pembroke, Ont.) | Year: 2013

Pediatric clinical research is dependent on obtaining consentfrom the parents or legal guardian of eligible patients. Little is known about parents' perspectives and the process by which they make the decision to enroll their child in a pediatric critical care trial. To describe the experience of parents/legal guardians who consented or declined consent for their child to be enrolled in a pediatric critical care research study. Factors that influenced parents' decisions and suggestions for improving and modifying the consent process were explored. This study used a qualitative descriptive research design. Seven semi-structured qualitative interviews were conducted with parents who had given or declined consent for their child to participate in a clinical research study while their child was in a pediatric critical care unit in one of two Canadian pediatric teaching hospitals. Parents were interviewed within 48 hours of their child's transfer from the PICU to a hospital ward unit. The interviews were audio recorded, transcribed, and analyzed using a content analysis method. Parental decision-making related to research consent in the context of pediatric critical care is influenced by specific characteristics of the consent encounter (timing, location, and information), parent (emotional state, decision-making style, familiarity with environment, past experience, and personal motivation), child (condition and response to pain/needles) and study (risk, method, burden, and benefit). Parents identified that the timing and ways in which they received information during the consent encounter could be improved. Pediatric critical care researchers can improve the parental consent encounter experience by considering how parents perceive the approach to consent for a research trial for their child to balance the need to support parents with the need for participants in pediatric critical care research trials.


Flament M.F.,Ottawa Hospital Research Institute | Bissada H.,Ottawa Hospital | Spettigue W.,Childrens Hospital of Eastern Ontario
International Journal of Neuropsychopharmacology | Year: 2012

The objective was to review scientific evidence for efficacy and safety of pharmacotherapy in adults or children with an eating disorder (ED). We conducted a computer search for all randomized controlled trials (RCTs) published between 1960 and May 2010 for treatment of anorexia nervosa (AN), bulimia nervosa (BN) or binge-eating disorder (BED). For drugs for which no RCT was found, open trials or case reports were retrieved. Clinically relevant RCTs in the treatment of AN have used atypical antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and zinc supplementation. Olanzapine demonstrated an adjunctive effect for in-patient treatment of underweight AN patients, and fluoxetine helped prevent relapse in weight-restored AN patients in 1/2 studies. For treatment of BN, controlled studies have used SSRIs, other antidepressants, and mood stabilizers. In 9/11 studies, pharmacotherapy yielded a statistically significant although moderate reduction in binge/purge frequency, and some additional benefits. For BED, RCTs have been conducted using SSRIs and one serotonin norepinephrine reuptake inhibitor (SNRI), mood stabilizers, and anti-obesity medications. In 11/12 studies, there was a statistically significant albeit limited effect of medication. Meta-analyses on efficacy of pharmacotherapy for BN and BED support moderate effect sizes for medication, but generally low recovery rates. Treatment resistance is an inherent feature of AN, where treatment should focus on renourishment plus psychotherapy. For BN and BED, combined treatment with pharmacotherapy and cognitive behaviour therapy has been more effective than either alone. Data on the long-term efficacy of pharmacotherapy for EDs are scarce. Short-and long-term pharmacotherapy of EDs still remains a challenge for the clinician. © 2011 CINP.


Feber J.,Childrens Hospital of Eastern Ontario | Ahmed M.,Childrens Hospital of Eastern Ontario
Clinical Science | Year: 2010

Childhood HTN (hypertension) has become a widely investigated topic within the last decade due to its increasing prevalence. In the present review, we examine new developments and trends that have significantly contributed to aetiology, diagnosis, evaluation and management of childhood HTN. Many recent reports document an increasing prevalence of HTN, mainly essential HTN, in children worldwide. This is probably related to the increase of childhood obesity, although obesity is not the only factor. Evidence has been accumulating to suggest a rather complex interplay between obesity, uric acid level, dietary sodium intake, inflammation, inheritance and other factors, which lead to increased risk of developing HTN in childhood and adulthood. The detection and monitoring of HTN has significantly improved with the use of ABPM (ambulatory blood pressure monitoring), which allows not only for a more accurate classification and staging of HTN, but also for the calculation of more sophisticated parameters such as the AASI (ambulatory arterial stiffness index). Measurement of arterial stiffness enables assessment of arterial dysfunction, which may precede structural vascular changes evaluated by carotid intima media thickness. Sustained HTN eventually leads to end-organ damage [LVH (left ventricular hypertrophy), central nervous system], which in turn increases the risk of cardiovascular morbidity and mortality. New developments in childhood HTN, as outlined in the present review, will hopefully contribute to better screening and management of HTN in children. © The Authors.


Orr S.L.,Childrens Hospital of Eastern Ontario
Cephalalgia | Year: 2016

Background The use of complementary and alternative medicines (CAM) is common among patients with primary headaches. In parallel, CAM research is growing. Diet interventions comprise another category of non-pharmacologic treatment for primary headache that is of increasing clinical and research interest. Methods A literature search was carried out to identify studies on the efficacy of diet and nutraceutical interviews for primary headache in the pediatric and adult populations. MEDLINE, Embase and EBM Reviews - Cochrane Central Register of Controlled Trials were searched to identify studies. Results There is a growing body of literature on the potential use of CAM and diet interventions for primary headache disorders. This review identified literature on the use of a variety of diet and nutraceutical interventions for headache. Most of the studies assessed the efficacy of these interventions for migraine, though some explored their role in tension-type headache and cluster headache. The quality of the evidence in this area is generally poor. Conclusions CAM is becoming more commonplace in the headache world. Several interventions show promise, but caution needs to be exercised in using these agents given limited safety and efficacy data. In addition, interest in exploring diet interventions in the treatment of primary headaches is emerging. Further research into the efficacy of nutraceutical and diet interventions is warranted. © International Headache Society.


Hunter A.G.,Childrens Hospital of Eastern Ontario
American Journal of Medical Genetics, Part A | Year: 2011

Temtamy and McKusick suggested mouse disorganization (Ds) as a model for human tibial agenesis, fibular duplication and mirror foot, but the concurrent papers by Winter and Donnai and Donnai and Winter in 1989 kindled interest and led to continued reports of patients hypothesized as human equivalent of Ds (HEDs). Subsequent reports have tended to follow one or other of the two categories outlined; (1) band/constriction with additional anomalies unexplained by bands (ABS); (2) patterns of malformation interpreted as resembling mouse Ds (non-ABS). A review of a series of cases led to a re-read of the original Ds mouse reports by Hummel in 1958 and 1959 and examination of current literature in an attempt to assess the strength of the argument that the patients might represent HEDs. Key to the approach was a paragraph in Hummel's introduction; "some of the developmental anomalies ... from action of Ds are similar to those caused by other ...genes...teratogens... others are unique..." The corollary is a patient is likelier to represent human DS if the anomaly(s) match these unique malformations/patterns. Presence of anomalies not specifically noted in Ds would weaken the argument for human equivalence. Reports of possible HEDs were ascertained using PubMed and literature cited by authors subsequent to the 1989 papers, up to and including January, 2010. This paper gives an overview of HEDs patients reported and concludes that the ABS type, even with non-band associated anomalies, is not likely to often represent HEDs. Many non-ABS HEDs patients had equally valid alternative hypothesis or diagnoses, malformations unreported or unusual for the Ds mouse, and/or paucity of the more unusual anomalies of the Ds mouse.© 2011 Wiley-Liss, Inc.


Thakor N.,Childrens Hospital of Eastern Ontario | Holcik M.,Childrens Hospital of Eastern Ontario | Holcik M.,University of Ottawa
Nucleic Acids Research | Year: 2012

Physiological and pathophysiological stress attenuates global translation via phosphorylation of eIF2α. This in turn leads to the reprogramming of gene expression that is required for adaptive stress response. One class of cellular messenger RNAs whose translation was reported to be insensitive to eIF2α phosphorylation-mediated repression of translation is that harboring an Internal Ribosome Entry Site (IRES). IRES-mediated translation of several apoptosis-regulating genes increases in response to hypoxia, serum deprivation or gamma irradiation and promotes tumor cell survival and chemoresistance. However, the molecular mechanism that allows IRES-mediated translation to continue in an eIF2α-independent manner is not known. Here we have used the X-chromosome linked Inhibitor of Apoptosis, XIAP, IRES to address this question. Using toeprinting assay, western blot analysis and polysomal profiling we show that the XIAP IRES supports cap-independent translation when eIF2α is phosphorylated both in vitro and in vivo. During normal growth condition eIF2α-dependent translation on the IRES is preferred. However, IRES-mediated translation switches to eIF5B-dependent mode when eIF2α is phosphorylated as a consequence of cellular stress. © The Author(s) 2011. Published by Oxford University Press.


Mack D.R.,Childrens Hospital of Eastern Ontario
Nutrients | Year: 2011

A complex set of interactions between the human genes encoding innate protective functions and immune defenses and the environment of the intestinal mucosa with its microbiota is currently considered key to the pathogenesis of the chronic inflammatory bowel diseases (IBD). Probiotics offer a method to potentially alter the intestinal microbiome exogenously or may provide an option to deliver microbial metabolic products to alter the chronicity of intestinal mucosal inflammation characterizing IBD. At present, there is little evidence for the benefit of currently used probiotic microbes in Crohn's disease or associated conditions affecting extra-intestinal organs. However, clinical practice guidelines are now including a probiotic as an option for recurrent and relapsing antibiotic sensitive pouchitis and the use of probiotics in mild ulcerative colitis is provocative and suggests potential for benefit in select patients but concerns remain about proof from trials. © 2011 by the authors; licensee MDPI, Basel, Switzerland.


Johnston D.L.,Childrens Hospital of Eastern Ontario | Vadeboncoeur C.,Outreach
Supportive Care in Cancer | Year: 2012

Purpose Pediatric oncology patients benefit from the involvement of palliative care. This study examined the timing of palliative care consultation. Methods A retrospective chart review was performed on all children from the Children's Hospital of Eastern Ontario with a diagnosis of malignancy. Results Since 2006, 50 children with cancer were referred to palliative care. The mean time of referral after diagnosis was 461 days, with 8(16%) referred within 30 days of diagnosis, 13(26%) before a relapse occurred, 20(40%) after the first relapse, and 9(18%) after ≥2 relapses. Of the 40 patients referred to palliative care who died, 28% died at home, 30% in hospital, and 43% in hospice. Of the 49 oncology patients who died during the study period, 88% received a palliative care consult prior to death. Conclusions The majority of children in this study who died from cancer were referred to palliative care. Oncologists should strive to refer patients early in their disease. © Springer-Verlag 2011.


El Emam K.,Childrens Hospital of Eastern Ontario
IEEE Security and Privacy | Year: 2010

This article describes a method for assessing the overall risk of re-identification for a health data set and how that risk information can be used to decide how much to de-identify the data before it's disclosed. Such an approach ensures that the amount of distortion to the data is proportionate to the risk involved in disclosing a particular data set to a particular data recipient. © 2006 IEEE.


Patent
Childrens Hospital Of Eastern Ontario | Date: 2015-07-03

There is provided a method of measuring methylcitrate (MCA) in a sample by derivatizing the MCA, for example with 4-[2-(N,N-dimethylamino)ethylaminosulfonyl]-7-(2-aminoethylamino)-2,1,3-benzoxadiazole (DAABD-AE); measuring a level of the derivatized MCA; and determining the level of MCA from the measured level. The sample may be a dried blood spot (DBS), and the extraction and derivatization may be carried out simultaneously. No separate extraction or purification step is required, thereby reducing sample handling. Measuring may be carried out by mass spectrometry. The method may be used to screen for subjects having or at increased risk of a propionylcarnitine (C3) related disorder. The method may be used as a first tier screen, or as a second tier test for a sample that previously triggered a positive result in a primary screen. The method may be applied to newborn screening. Related kits and uses are also provided.

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