Paediatrics & child health最新文献

{"title":"A mixed-methods exploration of the Real-Time Virtual Support pathway Child Health Advice in Real-Time Electronically in Northwestern BC.","authors":"Sean Duke, Jenna Treissman, Shannon Freeman, Emma Rossnagel, Salima Somani, Alam Lakhani, Kirsten Miller, John Pawlovich, David Wensley","doi":"10.1093/pch/pxae063","DOIUrl":"10.1093/pch/pxae063","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the implementation of a provincial virtual paediatric consulting service, Child Health Advice in Real-Time Electronically (CHARLiE), integrated into the paediatric on-call schedule in Northwestern British Columbia.</p><p><strong>Methods: </strong>Healthcare providers in Northwestern British Columbia responded to a survey (n = 72) and participated in focus groups (n = 35) and key informant interviews (n = 4) to share their experiences engaging in a healthcare model that incorporated virtual paediatric consultants in lieu of in-person local paediatrician coverage over a 28-month period. Survey data was analyzed using descriptive statistics. Themes were generated from a qualitative descriptive approach to focus groups and key informant interview transcripts.</p><p><strong>Results: </strong>96.1% of survey respondents who had used CHARLiE rated it as 'good' or 'very good' in the provision of overall support, while 77.6% reported that CHARLiE improved access to paediatric care. Focus group and key informant interview participants valued CHARLiE's timely, dedicated virtual bedside assessments of patients; collegiality and professionalism; amelioration of local paediatrician burnout; prevention of unnecessary transfers; and offloading of indirect patient care tasks. Video support improved provider confidence and appeared to improve caregiver trust. Suggested improvements included addressing technological barriers, enhancing providers' knowledge of local resources, and enabling continuity of care. Participants identified that virtual care does not replace on-the-ground specialist care.</p><p><strong>Conclusions: </strong>Participants valued CHARLiE's 24/7, timely, and collegial video support. While maintaining a full complement of on-the-ground paediatricians remains the goal for some rural communities, dedicated virtual support provides access to paediatric care in smaller communities, thereby improving health equity for children in British Columbia.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"29 6","pages":"346-353"},"PeriodicalIF":1.8,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased access to pediatric specialist healthcare using eConsult: A retrospective observational cohort and case-control study.","authors":"Lillian Lai, Sophia Roubos, Dhenuka Radhakrishnan, Eric I Benchimol, Xuesong Wang, Lavina Matai, Erin Keely, Clare Liddy, Kimmo Murto","doi":"10.1093/pch/pxae047","DOIUrl":"10.1093/pch/pxae047","url":null,"abstract":"<p><strong>Objectives: </strong>Primary care practitioners (PCPs) report that using the Champlain BASE™ eConsult service (eConsult) averts one-third of face-to-face (FTF) specialist referrals, however, there are concerns about duplication of services and adverse patient outcomes. Following an eConsult, we evaluated patient healthcare utilization and associated treatment costs.</p><p><strong>Methods: </strong>Retrospective cohort study (2014 to 2018) of patients (<18 years old) for whom an eConsult visit averted a FTF specialist referral. Patients were linked to provincial health administrative databases and hospital electronic medical records for healthcare use for the same diagnosis and specialty for the 18 months following the eConsult. Concurrently, a retrospective case-control study compared utilization and costs between an eConsult versus a matched FTF visit for the same diagnosis. We also assessed PCP satisfaction.</p><p><strong>Results: </strong>In follow-up, <5% of the study cohort of eConsult patients (n = 242) later accessed the healthcare system for the identical diagnosis and specialty type. FTF visits generate more frequent outpatient visits (12.6 times more [95% CI: 2.28 to 69.66, P = 0.002]) and higher costs compared to eConsult visits. There were no hospital admissions or deaths in patients with eConsult. PCPs (98%) described eConsult as an excellent service.</p><p><strong>Conclusions: </strong>Using eConsult is associated with <5% of patients subsequently having a FTF visit for the same reason. Matched FTF visits generated more healthcare utilization and higher costs compared with eConsult. eConsult in pediatrics is safe and can minimize FTF specialist visits in elective cases and increase capacity, towards a more efficient and cost-effective healthcare system.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"30 3","pages":"108-115"},"PeriodicalIF":1.8,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Response to the Canadian Paediatric Position Statement on transgender and gender-diverse youth.","authors":"Chan Kulatunga Moruzi, Ian Mitchell, Darrell Palmer, Roxanne Goldade","doi":"10.1093/pch/pxae070","DOIUrl":"10.1093/pch/pxae070","url":null,"abstract":"","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"29 6","pages":"413-414"},"PeriodicalIF":1.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to my Younger Colleagues: \"Don't cry because it's over…\".","authors":"Ellen Wood","doi":"10.1093/pch/pxae054","DOIUrl":"https://doi.org/10.1093/pch/pxae054","url":null,"abstract":"","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"29 6","pages":"411-412"},"PeriodicalIF":1.8,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Critical Lens: It is time to start using the right test for febrile young infants.","authors":"Adiel Marom, Jesse Papenburg, Brett Burstein","doi":"10.1093/pch/pxae069","DOIUrl":"10.1093/pch/pxae069","url":null,"abstract":"<p><p>Fever among infants in the first months of life is a common clinical conundrum facing all clinicians who treat children. Most well-appearing febrile young infants have viral illnesses. However, it is critical to identify those at risk of invasive bacterial infections, specifically bacteremia and bacterial meningitis. Clinicians must balance the risks of missing these infections against the harms of over-investigation. Procalcitonin testing is currently the best diagnostic test available to help guide management, and the Canadian Paediatric Society Position Statement on the management of febrile young infants recommends procalcitonin-based risk stratification. However, in many clinical settings, procalcitonin is either unavailable or has a turnaround time that is too long to aid decision-making. Clinicians who care for febrile young infants must have rapid access to procalcitonin results to provide best-evidence, guideline-adherent care. The wider availability of this test is essential to reduce unnecessary invasive testing, hospitalizations, and antibiotic exposure and could reduce system-wide resource utilization.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"29 7","pages":"419-421"},"PeriodicalIF":1.8,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics influencing timing of cerebral palsy diagnosis in neonatal follow-up.","authors":"Marina M Journault, Lara M Leijser, Scott A McLeod, Selphee Tang, Elsa Fiedrich, Amanda M Moe, Amina A Benlamri","doi":"10.1093/pch/pxae068","DOIUrl":"10.1093/pch/pxae068","url":null,"abstract":"<p><strong>Objectives: </strong>To describe clinical characteristics influencing the timing of cerebral palsy (CP) diagnosis in a traditional neonatal follow-up clinic (NFC) setting.</p><p><strong>Methods: </strong>Retrospective observational cohort study involving preterm infants, born <29 weeks gestation and/or birthweight <1000 g between January 2005 and December 2014, with CP and followed in Calgary's NFC. Infant data were collected, including demographics, perinatal and neonatal parameters, cranial ultrasound (cUS) results, co-occurring conditions, and CP characteristics (timing of suspicion and diagnosis, type, topography, distribution, and Gross Motor Function Classification System [GMFCS] level). This cohort was divided into two groups, early (diagnosed <19 months corrected age [CA]) and late (diagnosed ≥19 months CA), based on the median age of CP diagnosis, and characteristics were compared.</p><p><strong>Results: </strong>A total of 99 infants met the inclusion criteria. Median age at first CP suspicion was 9 months CA (interquartile range [IQR] 14) and median age at diagnosis was 19 months CA (IQR 17), with median time lag from suspicion to diagnosis of 6 months (IQR 12). CP characteristics associated with diagnosis at an earlier age included higher GMFCS level, mixed type (compared to spastic only), and upper and lower extremities involvement. Infant characteristics, severity of cUS results, and co-occurring conditions were not different between early and late groups.</p><p><strong>Conclusions: </strong>CP diagnosis timing is affected by GMFCS level, motor type, and distribution. Especially in infants with CP involving less motor impairment, there is a prolonged delay between CP suspicion and formal diagnosis. This gap may be amenable to quality improvement initiatives aimed at targeted implementation of early assessment tools.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"30 3","pages":"126-133"},"PeriodicalIF":1.8,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Streptococcus pneumoniae</i>-associated hemolytic uremic syndrome Canadian Immunization Monitoring Program ACTive National Pediatric Surveillance (1991 to 2019).","authors":"Lauren Dagyung Lee, Nirma Khatri Vadlamudi, Katherine Yu, Manish Sadarangani, Nicole Le Saux, Joanne Embree, James D Kellner, Shaun K Morris, Scott A Halperin, Julie A Bettinger","doi":"10.1093/pch/pxae055","DOIUrl":"10.1093/pch/pxae055","url":null,"abstract":"<p><strong>Objectives: </strong><i>Streptococcus pneumoniae</i>-associated hemolytic uremic syndrome (SP-HUS) is an underreported cause of pediatric atypical HUS. This study describes the epidemiology of the largest Canadian case series of SP-HUS in comparison with non-HUS invasive pneumococcal disease (IPD).</p><p><strong>Methods: </strong>The Canadian Immunization Monitoring Program, ACTive (IMPACT) is a national surveillance network for vaccine-preventable diseases. All confirmed IPD cases from 1991 through 2019 were included in the analysis. IPD cases with new HUS diagnoses were identified as SPHUS cases, and the rest as non-HUS IPD.</p><p><strong>Results: </strong>There were 30 (0.4%) cases of SP-HUS amongst 6757 IPD cases. The median age of SP-HUS cases was 27.5 months, with no significant differences between SP-HUS and non-HUS cases in age or sex. <i>Streptococcus pneumoniae</i> serotypes 3 (30%) and 19A (26.7%) were more common in SP-HUS compared to non-HUS (P < 0.0001). Pneumonia was more frequently observed in SPHUS than in non-HUS (67% versus 26%; P < 0.0001). All SP-HUS cases were hospitalized, compared with 71% of non-HUS IPD cases (P = 0.0004). SP-HUS cases had a longer median hospital length of stay than non-HUS (23.5 versus 7 days; P < 0.0001) and a higher proportion required an Intensive Care Unit (ICU) admission (70% versus 15.5%; P < 0.0001). Moreover, ICU stays were longer in HUS cases compared with non-HUS cases (9 versus 3 days; P < 0.0001). All 30 SP-HUS patients survived while 3% of non-HUS cases died (P = 0.33).</p><p><strong>Conclusions: </strong>SP-HUS was usually seen in IPD cases with pneumonia and was most commonly caused by serotypes 3 and 19A. ICU care was lengthy, hospital stay was longer. No deaths occurred among SP-HUS cases.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"30 2","pages":"78-82"},"PeriodicalIF":1.8,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gene-based drug therapy for children and youth treated with psychoactive medications.","authors":"Ruud H J Verstegen, Iris Cohn, Mark E Feldman, Daniel Gorman, Shinya Ito","doi":"10.1093/pch/pxae029","DOIUrl":"10.1093/pch/pxae029","url":null,"abstract":"<p><p>Psychoactive medications are increasingly used to treat children and youth with mental health conditions, but individual variations in response highlight the need for precision medicine. Pharmacogenetic (PGx) testing is a key component of precision medicine. The number of commercial pharmacogenetic testing companies promoting PGx, with the promise of achieving individualized and effective treatment of mental health conditions, has grown exponentially in recent years. Scientific evidence supporting the use of PGx to manage mental health conditions is limited, especially for paediatric populations. This practice point outlines steps guiding the use and interpretation of PGx testing for psychoactive medications in clinical settings, along with key supportive resources. Practice guidelines have been developed for variants in pharmacogenes encoding cytochrome P450 drug-metabolizing enzymes (e.g., <i>CYP2C19</i>, <i>CYP2D6</i>, <i>CYP2C9</i>) as one determinant of drug concentrations in blood, which can support both drug choice and dosing strategy for certain anti-psychotics, anti-depressants, and anti-epileptics. Adverse drug reactions to some anti-epileptic drugs (e.g., carbamazepine and phenytoin) have been associated with certain human leukocyte antigen types and variants in DNA polymerase gamma (<i>POLG</i>; valproic acid). Evidence remains limited for genetic variants of drug target proteins, making it challenging to identify patients with altered treatment responses at a therapeutic blood concentration.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"29 5","pages":"311-323"},"PeriodicalIF":1.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving cycling safety for children and youth.","authors":"Daniel Rosenfield, Pamela Fuselli, Suzanne Beno","doi":"10.1093/pch/pxae035","DOIUrl":"10.1093/pch/pxae035","url":null,"abstract":"<p><p>Cycling remains a popular activity for children and youth around the world, combining the fun of moving at speed with numerous health and societal benefits. However, cycling is also associated with risk for serious injury and death. Over the past decade, research has increasingly shown that improving safety for cyclists depends, in large part, on the environment they are cycling in as well as on individual safety measures such as helmet use. The pandemic provided greater opportunity for many children and youth to engage in cycling, and refocused public attention on safer cycling infrastructure such as protected bike lanes. This statement reviews the evidence supporting safer cycling infrastructure for children and youth along with the physical and mental health benefits of cycling. The advantages of active transportation for young people, and how the built environment influences their cycling safety and uptake, are discussed. An overview of measures individuals can take to improve cycling safety is followed by recommendations for clinicians, the cycling community, parents, and policy-makers.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"29 5","pages":"324-334"},"PeriodicalIF":1.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La pharmacothérapie en fonction des gènes chez les enfants et les adolescents qui prennent des médicaments psychoactifs.","authors":"Ruud H J Verstegen, Iris Cohn, Mark E Feldman, Daniel Gorman, Shinya Ito","doi":"10.1093/pch/pxae028","DOIUrl":"10.1093/pch/pxae028","url":null,"abstract":"<p><p>Les médicaments psychoactifs sont de plus en plus utilisés pour traiter les enfants et les adolescents ayant des troubles de santé mentale, mais la variabilité des réponses individuelles fait ressortir l'importance d'une médecine personnalisée. Les tests pharmacogénétiques sont un volet important d'un tel type de médecine. Le nombre d'entreprises de tests pharmacogénétiques commerciaux qui font la promotion de tests de ce genre et promettent un traitement efficace et individualisé des troubles de santé mentale se multiplie depuis quelques années. Les preuves scientifiques en appui à l'utilisation de la pharmacogénétique sont limitées, particulièrement dans les populations pédiatriques. Le présent point de pratique souligne les étapes qui orientent le recours à ces tests pour la prise de médicaments psychoactifs en milieu clinique et présente des ressources de soutien importantes. Il existe des directives cliniques sur les variants des pharmacogènes qui encodent les enzymes de métabolisation du cytochrome P450 (p. ex., <i>CYP2C19</i>, <i>CYP2D6</i>, <i>CYP2C9</i>), lesquels sont l'un des déterminants des concentrations pharmacologiques dans le sang et peuvent appuyer à la fois le choix du médicament et la stratégie posologique de certains antipsychotiques, antidépresseurs et antiépileptiques. Les effets indésirables de certains médicaments antiépileptiques (p. ex., la carbamazépine et la phénytoïne) sont associés à certains types d'antigènes d'histocompatibilité humaine et à des variants de l'ADN polymérase gamma (<i>POLG</i>; acide valproïque). Les données probantes sont limitées à l'égard des variants génétiques des protéines qui ciblent les médicaments, et c'est pourquoi il est difficile de déterminer quels patients présenteraient une réponse altérée au traitement à une concentration sanguine thérapeutique.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"29 5","pages":"311-323"},"PeriodicalIF":1.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}