Trauma association of Canada Pediatric Subcommittee National Pediatric Cervical Spine Evaluation Pathway: consensus guidelines.

BACKGROUND: The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and improve patient outcomes. In 2006, The Trauma Association of Canada Pediatric Committee set out to create an evidence-based, national pediatric cervical spine (c-spine) clearance guideline based on the literature, existing algorithms from each pediatric trauma center and from expert opinion from across Canada. METHODS: A review of the literature took place in September 2006 using the PubMed database. Search criteria were "cervical spine," "c-spine," "clearance," and "trauma." Limits that were applied were "Languages: English," "Humans," "Type of Article: Meta-Analysis, Practice Guidelines, Randomized Control Trial, Review," and "Ages: all child 0-18 years." These search criteria were repeated in December 2007, April 2009, and October 2009. A total of 248 articles were identified. Existing guidelines were identified and their practices examined as models of care. Two draft guidelines were created for discussion: one for the pediatric patient with a reliable clinical examination and the other for the pediatric patient with an unreliable clinical examination. Via email, telephone, and two national videoconferences, the content of the guidelines was reviewed, discussed, and amended. The final article was prepared and circulated for author input until consensus was reached. RESULTS: A consensus was reached on two pathways to evaluate the pediatric cervical spine: a patient with a reliable clinical examination and a patient with an unreliable examination. CONCLUSION: Presented herein are the consensus Trauma Association of Canada, National Pediatric Cervical Spine Evaluation Pathways for the patient with a reliable clinical examination, and the patient with and unreliable clinical examination.

Quality assessment in primary health care: Adolescent and Youth Friendly Service, a Mozambican case study.

INTRODUCTION: despite the Mozambican Ministry of Health's efforts to deliver family planning to all girls of childbearing age, the adolescent pregnancy rate remains high. The Adolescent and Youth Friendly Service (AYFS), integrated into overall primary health care programs throughout the country, aims to reverse this situation. Our study objective was to assess this health care service's quality in its location in Marrere Health Centre, Nampula, northern Mozambique, using clients' perspective. METHODS: we implemented a descriptive cross-sectional quantitative study sampling 124 individuals, who had recently accessed the AYFS at Marrere Health Centre. Data were collected through a questionnaire using a 5-point Likert scale in questions regarding satisfaction level (i.e. always, most times, sometimes, few times, never) and additional open answer questions to gain greater specific understanding. RESULTS: a total of 126 users of the AYFS were evaluated, all from the Emacua ethnic-linguistic group. 85 (67%) were adolescents (<19 years), 78.2% female. The mean age was 17.6 years. We found an average of 0.54 pregnancies per woman and 87 participants (69%) never had a pregnancy; of 39 (31%) who had been pregnant, 17 (44%) were able to report the date of the first prenatal visit, on average performed at week 16 (2nd trimester), though with 9 (53%) having performed it during the first trimester. Spontaneous and induced abortions were reported respectively in 4 and 34 cases, respectively, and none with adolescents. The "overall satisfaction" rate was more frequent in both groups, being answered by 93.8% of youth and adults (>= 19 years) and 72.0% of adolescents, a statistically significant difference between the two groups (p <0.05). CONCLUSION: while most users are satisfied with the services there was, however, some sharp criticism. Health professionals' practice with the protocol varied, and there were significant deficiencies in information and communication with users. Open communication within families and information reinforcement about sexual and reproductive health and male participation in family planning were found to be in need of strengthening. Our recommendations include reinforcing health professional's training to protect adolescents and young people' sexual health, an important strategy in primary health care to achieve universal health coverage.

Healthy active living: A goal or a mirage? A survey of Canadian paediatricians.

Childhood obesity is a major health concern. Inactivity is a major cause of this epidemic. The Healthy Active Living Committee of the Canadian Paediatric Society sampled 1866 paediatricians across Canada to assess members' knowledge of healthy active living (HAL), how they currently use HAL materials, what new materials would be most useful, and who would be most likely to carry the messages forward. The survey had only a 16% response rate. The results are published to help educate members, demonstrate the apparent lack of interest in a decidedly important area (and give reasons for this apathy), provide members with information on HAL materials, and update members on HAL committee actions since the survey was sent.

Treatment of children with migraine in emergency departments: national practice variation study.

OBJECTIVE: Children with migraine may present to an emergency department (ED) when outpatient management has failed; however, only limited research has examined migraine-abortive medications among children. METHODS: A retrospective chart review of ED presentations for migraine or headache between July 1, 2004, and June 30, 2005, in 10 Canadian pediatric EDs was conducted. A priori, evidence-based treatments were defined as any treatment that was based on high-quality evidence and an absence of opioids as first-line agents. RESULTS: A total of 2515 records were screened, and 1694 (67.4%) met inclusion criteria. The average age of patients was 12.1 years, 14.5% (95% confidence interval [CI]: 12.1%-17.2%) of patients experienced headache >15 days per month, and 62.6% (95% CI: 55.7%-68.9%) had already used migraine-abortive therapy. Significant variations in practice for all classes of migraine-abortive medications were observed. Dopamine receptor antagonists (prochlorperazine, metoclopramide, or chlorpromazine) (39% [95% CI: 28.4%-50.8%]) and orally administered analgesics (acetaminophen and ibuprofen) (24.5% [95% CI: 23.9%-46.8%]) were prescribed most commonly. Predictors for the use of evidence-based treatment included older age (odds ratio: 1.15 [95% CI: 1.07-1.24]) and a discharge diagnosis of migraine (odds ratio: 1.84 [95% CI: 1.11-3.05]). CONCLUSIONS: Children presenting to EDs for treatment often have frequent attacks and have experienced failure of outpatient, migraine-abortive efforts. Practice variations were impressive for the care of children with migraine in these Canadian EDs.