10 research outputs found
Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments: A Nationwide Study
Objectives The aim of this study was to quantify the effect of the COVID-19 pandemic on pediatric emergency department (ED) utilization and outcomes. Methods This study is an interrupted-Time-series observational study of children presenting to 11 Canadian tertiary-care pediatric EDs. Data were grouped into weeks in 3 study periods: prepandemic (January 1, 2018-January 27, 2020), peripandemic (January 28, 2020-March 10, 2020), and early pandemic (March 11, 2020-April 30, 2020). These periods were compared with the same time intervals in the 2 preceding calendar years. Primary outcomes were number of ED visits per week. The secondary outcomes were triage acuity, hospitalization, intensive care unit (ICU) admission, mortality, length of hospital stay, ED revisits, and visits for trauma and mental health concerns. Results There were 577,807 ED visits (median age, 4.5 years; 52.9% male). Relative to the prepandemic period, there was a reduction [-58%; 95% confidence interval (CI),-63% to-51%] in the number of ED visits during the early-pandemic period, with concomitant higher acuity. There was a concurrent increase in the proportion of ward [odds ratio (OR), 1.39; 95% CI, 1.32-1.45] and intensive care unit (OR, 1.20; 95% CI, 1.01-1.42) admissions, and trauma-related ED visits among children less than 10 years (OR, 1.51; 95% CI, 1.45-1.56). Mental health-related visits in children declined in the early-pandemic period (in \u3c10 years,-60%; 95% CI,-67% to-51%; in children ≥10 years:-56%; 95% CI,-63% to-47%) relative to the pre-COVID-19 period. There were no differences in mortality or length of stay; however, ED revisits within 72 hours were reduced during the early-pandemic period (percent change:-55%; 95% CI,-61% to-49%; P \u3c 0.001). Conclusions After the declaration of the COVID-19 pandemic, dramatic reductions in pediatric ED visits occurred across Canada. Children seeking ED care were sicker, and there was an increase in trauma-related visits among children more than 10 years of age, whereas mental health visits declined during the early-pandemic period. When faced with a future pandemic, public health officials must consider the impact of the illness and the measures implemented on children\u27s health and acute care needs
The impact of category, cytopathology and cytogenetics on development and progression of clonal and malignant myeloid transformation in inherited bone marrow failure syndromes
Inherited bone marrow failure syndromes are a group of rare, heterogeneous genetic disorders with a risk of clonal and malignant myeloid transformation including clonal marrow cytogenetic abnormalities, myelodysplastic syndrome and acute myeloid leukemia. The clinical characteristics, risk classification, prognostic factors and outcome of clonal and malignant myeloid transformation associated with inherited bone marrow failure syndromes are largely unknown. The aims of this study were to determine the impact of category, cytopathology and cytogenetics, the three components of the “Category Cytology Cytogenetics” classification of pediatric myelodysplastic syndrome, on the outcome of clonal and malignant myeloid transformation associated with inherited bone marrow failure. We used data from the Canadian Inherited Marrow Failure Registry. Among 327 patients with inherited bone marrow failure syndrome enrolled in the registry, the estimated risk of clonal and malignant myeloid transformation by the age of 18 years was 37%. The risk of clonal and malignant myeloid transformation varied according to the type of inherited bone marrow failure syndrome but was highest in Fanconi anemia. The development of clonal and malignant myeloid transformation significantly affected overall survival. Mortality varied based on cytopathological group. The largest group of patients had refractory cytopenia. Clonal marrow cytogenetic abnormalities were identified in 87% of patients with clonal and malignant myeloid transformation, and different cytogenetic groups had different impacts on disease progression. We conclude that category, cytopathology and cytogenetics in cases of clonal and malignant myeloid transformation associated with inherited bone marrow failure syndromes have an important impact on outcome and that the classification of such cases should incorporate these factors
Identifying Facilitators of and Barriers to Digital Health Literacy in Chronic Childhood Rheumatic Disease - Scoping Review Protocol
The adoption of digital health – using technology to delivery, manage, communicate about, and improve health – is a healthcare trend that was intensified by the COVID-19 pandemic. To be able to use and gain benefit from digital health, users must have a set of skills necessary to be able to access, assess, utilize, and incorporate the technology and the health information into their health behaviours. These skills are known as digital health literacy (DHL). Higher levels of DHL are associated with better health-related outcomes and chronic disease management, while lower levels of DHL are a barrier to accessing care, disease education, and is associated with poor health outcomes.
Pediatric rheumatic diseases are a class of chronic systemic inflammatory disorders that include an array of musculoskeletal and connective tissue disorders, with Juvenile Idiopathic Arthritis (JIA) being the most common. All childhood rheumatic diseases can have adverse effects on growth, quality of life (QoL), academic performance, psychosocial development, coping mechanisms, mental health, and transitioning to adult health care. Digital health has the possibility to allow children, adolescents, and parents affected by childhood chronic rheumatic disease to learn about the disease, manage side effects of treatments, interact with patient and parent groups, gain benefit from advocacy and educational associations, and digitally communicate with health care providers may impact health in this population. Conversely, low DHL has been linked to poor health outcomes and the exaggeration of pre-existing health and social disparities.
Facilitators of and barriers to DHL in identified in the existing literature were limited to children, adolescents, and parents without chronic diseases, non-rheumatic chronic diseases, or in adults with chronic rheumatic disease. The identified facilitators to DHL identified in the literature are found in those with higher socioeconomic status (SES), self-efficacy, frequent internet usage, and urban living. Barriers to DHL identified in the literature includes decreasing SES, age 65 years and older, lower frequency of internet usage, presence of comorbidities, primary language other than English, and being Black. These findings may be not generalizable across populations, diagnoses, research sites, and standards in care.
There is no standard way to investigate or report findings around DHL nor are there standard, unified definitions related to DHL. This study uses the terms "facilitators" and "barriers", but these are not universally accepted terms. We use "facilitators of DHL" to define any factors that improve DHL. The term "barriers to DHL" denotes the opposite: any factors that impede DHL and inhibit the use of digital health services. Likewise, studies conducting qualitative measures of DHL will also be considered. The most widely used DHL assessment tool is the self-reported eHealth Literacy Scale (eHEALS).
The aim of this study is to systematically survey the existing healthcare and educational databases for knowledge on facilitators of and barriers to DHL in children and adolescents with chronic rheumatic conditions and in the parents children and adolescents with chronic rheumatic conditions
The happy docs study: a Canadian Association of Internes and Residents well-being survey examining resident physician health and satisfaction within and outside of residency training in Canada
Background.
Few Canadian studies have examined stress in residency and none have included a large sample of resident physicians. Previous studies have also not examined well-being resources nor found significant concerns with perceived stress levels in residency. The goal of "The Happy Docs Study" was to increase knowledge of current stressors affecting the health of residents and to gather information regarding the well-being resources available to them.
Findings
A questionnaire was distributed to all residents attending all medical schools in Canada outside of Quebec through the Canadian Association of Internes and Residents (CAIR) during the 2004–2005 academic years.
In total 1999 resident physicians responded to the survey (35%, N = 5784 residents). One third of residents reported their life as "quite a bit" to "extremely" stressful (33%, N = 656). Time pressure was the most significant factor associated with stress (49%, N = 978). Intimidation and harassment was experienced by more than half of all residents (52%, N = 1050) with training status (30%, N = 599) and gender (18%, N = 364) being the main perceived sources. Eighteen percent of residents (N = 356) reported their mental health as either "fair" or "poor". The top two resources that residents wished to have available were career counseling (39%, N = 777) and financial counseling (37%, N = 741).
Conclusion
Although many Canadian resident physicians have a positive outlook on their well-being, residents experience significant stressors during their training and a significant portion are at risk for emotional and mental health problems. This study can serve as a basis for future research, advocacy and resource application for overall improvements to well-being during residency.Medicine, Faculty ofSurgery, Department ofOther UBCNon UBCReviewedFacult
An international study of trainee-trained transitions:Introducing the transition-to-trained-doctor (T3D) model
Background: Throughout their careers, doctors and other healthcare professionals experience numerous transitions. When supporting transitions, opportunities for development and learning should be maximized, while stressors having negative impacts on well-being should be minimized. Building on our international data, this study aimed to develop a conceptual model of the trainee-trained transition (i.e. the significant transitions experienced by doctors as they complete postgraduate training moving from trainee/resident status to medical specialist roles).
Methods: Employing Multiple and Multidimensional Transitions (MMT) theory and current conceptualizations of clinical context, this study undertook secondary analysis of 55 interviews with doctors from three countries (Netherlands, Cananda and the UK) undergoing trainee-trained transitions.
Results: Through this analysis, the Transition-To-Trained-Doctor (T3D) conceptual model has been developed. This model takes into consideration the multiple contexts and multiple domains in which transitions take place.
Discussion: This model is significant in that it has several uses and is applicable across countries: to remind doctors, managers and medical educators of the complexity of transitions; to frame and facilitate supportive conversations; and as a basis to teach about transitions
Androgen therapy in inherited bone marrow failure syndromes: analysis from the Canadian Inherited Marrow Failure Registry.
Progressive cytopenia is a serious complication among paediatric patients with inherited bone marrow failure syndromes (IBMFS). Androgens have been used to improve blood counts in different bone marrow failure conditions. Little is known about efficacy and toxicity with new androgens (i.e., danazol) in different types of IBMFS. We identified 29 patients from the Canadian Inherited Marrow Failure Registry, who received oxymetholone or danazol. Sixteen (55%) had haematological response including patients with unclassified IBMFS (45%). Danazol showed a better toxicity profile and similar efficacy compared to oxymetholone. Androgens are an effective and safe option to ameliorate bone marrow failure in IBMFS