In focus: perplexing increase of urinary stone disease in children, adolescent and young adult women and its economic impact.

Background: Urinary stone disease (USD) historically has affected older men, but studies suggest recent increases in women, leading to a near identical sex incidence ratio. USD incidence has doubled every 10 years, with disproportionate increases amongst children, adolescent, and young adult (AYA) women. USD stone composition in women is frequently apatite (calcium phosphate), which forms in a higher urine pH, low urinary citrate, and an abundance of urinary uric acid, while men produce more calcium oxalate stones. The reasons for this epidemiological trend are unknown. Methods: This perspective presents the extent of USD with data from a Canadian Province and a North American institution, explanations for these findings and offers potential solutions to decrease this trend. We describe the economic impact of USD. Findings: There was a significant increase of 46% in overall surgical interventions for USD in Ontario. The incidence rose from 47.0/100,000 in 2002 to 68.7/100,000 population in 2016. In a single United States institution, the overall USD annual unique patient count rose from 10,612 to 17,706 from 2015 to 2019, and the proportion of women with USD was much higher than expected. In the 10-17-year-old patients, 50.1% were girls; with 57.5% in the 18-34 age group and 53.6% in the 35-44 age group. The roles of obesity, diet, hormones, environmental factors, infections, and antibiotics, as well as the economic impact, are discussed. Interpretation: We confirm the significant increase in USD among women. We offer potential explanations for this sex disparity, including microbiological and pathophysiological aspects. We also outline innovative solutions - that may require steps beyond typical preventive and treatment recommendations.

Families' Knowledge Change in Paediatric Drug Resistant Epilepsy: A Novel Clinic Model.

BACKGROUND: Epilepsy is a chronic condition that affects approximately 95,000 Ontarians, of whom approximately 15,000 are children under the age of 18. Drug resistant epilepsy (DRE) will affect around 30% of these children who will require more advanced care due to their medical complexities. The purpose of this study is to determine if receiving care in a paediatric Comprehensive Epilepsy Clinic (CEC) is associated with positive outcomes for children living with DRE and their families by looking at three health outcomes: 1) families' knowledge of their child's diagnosis and treatment plan, 2) navigational access to both the hospital and community epilepsy services, and 3) health behaviours. METHODS: This was a prospective cohort study in which families of children diagnosed with DRE would be exposed to a CEC care model for the first time and followed for 6-months after enrollment. This was analyzed by utilizing surveys from new families at baseline and 6 months post receiving care within a CEC. RESULTS: Results revealed a statistical significance in change of knowledge in families' knowing the type of epilepsy their child has and what epilepsy co-morbidities are. Families' also had a significant change in utilizing hospital epilepsy resources and knowing who to contact in the community and hospital for their epilepsy related questions. CONCLUSION: A CEC model improves families' knowledge about epilepsy diagnosis and treatment plan, navigational access to both the hospital and community epilepsy services, and health behaviours.

Qualitative analysis of values and motivation reported by families utilizing a paediatric virtual care emergency clinic launched during the SARS-CoV-2 pandemic.

PURPOSE: This is the first study to take an in-depth qualitative approach to identify motivating factors for caregivers who chose the paediatric emergency virtual care option in Canada during the SARS-CoV-2 pandemic. The role that virtual care may play moving forward is also considered. METHODS: Between May 2020 and May 2021, 773 respondents attending the virtual clinic completed a follow-up survey with open-ended questions. For qualitative content analysis, comments were coded and analysed until thematic saturation was reached. Sub-codes were subsumed into major coding categories to identify themes. RESULTS: Three major themes, including safety, reassurance and convenience, and an overarching theme of satisfaction emerged from this analysis. Paediatric virtual clinic use was motivated in part by a desire to avoid the hospital environment. In-person Emergency Department visits were reported to be challenging and stressful, particularly due to perceived infection risk. Respondents appreciated that the clinic provided reassurance by assisting in navigating the healthcare system during a time of uncertainty and felt the virtual option allowed them to use healthcare resources responsibly. The convenience and ease of access to virtual care allowed for improved family-centred care in vulnerable populations. The overarching theme of satisfaction was emphasized by numerous comments for this service to be offered post-pandemic. CONCLUSION: Our study indicates that virtual care was an attractive option for caregivers due to the safety, reassurance, and convenience provided. The strong patient desire for continued availability post-pandemic will be important considerations in this rapidly developing area of care.

RéSUMé: OBJECTIF: Il s'agit de la première étude à adopter une approche qualitative approfondie pour identifier les facteurs de motivation des aidants qui ont choisi l'option des soins virtuels d'urgence pédiatrique au Canada pendant la pandémie de SRAS-CoV-2. Le rôle que les soins virtuels pourraient jouer à l'avenir est également envisagé. MéTHODES: Entre mai 2020 et mai 2021, 773 personnes ayant participé à la clinique virtuelle ont répondu à une enquête de suivi comportant des questions ouvertes. Pour l'analyse qualitative du contenu, les commentaires ont été codés et analysés jusqu'à ce que la saturation thématique soit atteinte. Les sous-codes ont été subsumés en grandes catégories de codage afin d'identifier les thèmes. RéSULTATS: Trois thèmes principaux, à savoir la sécurité, le réconfort et la commodité, ainsi qu'un thème général de satisfaction ont émergé de cette analyse. L'utilisation de la clinique virtuelle pédiatrique a été motivée en partie par le désir d'éviter l'environnement hospitalier. Les visites en personne dans les services d'urgence ont été jugées difficiles et stressantes, notamment en raison du risque d'infection perçu. Les personnes interrogées ont apprécié que la clinique les rassure en les aidant à s'orienter dans le système de santé pendant une période d'incertitude et ont estimé que l'option virtuelle leur permettait d'utiliser les ressources de santé de manière responsable. La commodité et la facilité d'accès aux soins virtuels ont permis d'améliorer les soins centrés sur la famille dans les populations vulnérables. Le thème général de la satisfaction a été souligné par de nombreux commentaires pour que ce service soit offert après la pandémie. CONCLUSION: Notre étude indique que les soins virtuels sont une option attrayante pour les aidants en raison de la sécurité, du réconfort et de la commodité qu'ils procurent. Le désir profond des patients de continuer à bénéficier de ces services après la pandémie sera un élément important à prendre en compte dans ce domaine de soins qui se développe rapidement.

Laryngeal Mask Airway for Surfactant Administration Versus Standard Treatment Methods in Preterm Neonates with Respiratory Distress Syndrome: A Systematic Review and Meta-analysis.

OBJECTIVE: Laryngeal mask airway (LMA) has emerged as an alternative surfactant delivery method. The effectiveness of this method for the delivery of surfactant is uncertain. A meta-analysis of randomized control trials (RCTs) comparing LMA with standard methods of surfactant delivery for the outcomes of surfactant dose repetition, oxygen requirement, mechanical ventilation, intubation, mortality, bronchopulmonary dysplasia (BPD), and pneumothorax. STUDY DESIGN: Systematic review and meta-analysis of RCTs. Homogeneity between studies was analyzed by using I2 statistics. Risk ratio or mean difference of outcomes was assessed from random effects models. Subgroup analyses were conducted when necessary. Data sources are as follows: Ovid Medline, Embase, and the Cochrane Central Register of Controlled trials from inception till December 2018, bibliographies of identified reviews and trial registries for ongoing studies. RCTs comparing short-term respiratory outcomes in neonates with respiratory distress syndrome who were administered surfactant through an LMA versus standard method of care. RESULTS: Six RCTs were identified, enrolling a total of 357 infants. Administering surfactant via LMA was associated with decreased FiO2 requirement (mean difference = 1.82 (95% confidence interval [CI]: -6.01-9.66), decreased intubation (risk ratio [RR] = 0.17; 95% CI: 0.05-0.57), and decreased mechanical ventilation (RR = 0.44; 95% CI: 0.31-0.61). There were no significant differences between groups for death, BPD, or pneumothorax. CONCLUSION: LMA might be an effective alternative method of surfactant delivery; however, further high-quality RCTs with larger sample size and including extreme preterm infants are needed to establish LMA as an alternative technique for surfactant delivery. KEY POINTS: · Pulmonary surfactants reduce mortality and pulmonary air leaks in newborns with respiratory distress syndrome.. · Preterm lungs are at risk of volutrauma by mechanical ventilation; laryngoscopy is still traumatic.. · Surfactant administration via LMA to avoid mechanical ventilation and intubation might be feasible..

Adolescent and caregiver attitudes towards telemedicine use in pediatric nephrology.

BACKGROUND: Telemedicine is increasingly utilized as an alternative to in person consultation. Current pandemic conditions are providing additional impetus to virtual care delivery. We compared both adolescent and caregiver (parent or guardian) attitudes towards telemedicine (here as tertiary center to remote health care location) as a crucial determinant of longer-term effectiveness. METHODS: This qualitative research study analyzed transcribed structured telephone interviews with both 11-18 year-old pediatric nephrology patients and their caregivers and performed a quantitative analysis of patient demographics, disease factors and distance to tertiary center vs. telemedicine center. RESULTS: The study was conducted in a medium-sized tertiary pediatric nephrology centre with a large catchment area of over 0.5 million square kilometers and 629,000 children and adolescents under 18 years of age. Eleven dyads of adolescents and caregivers were enrolled. Five adolescents were male. The mean age of the adolescents was 14.4 ± 2.5 years (range 11.2-18.0). The median distance to our tertiary center was 191 km (range 110-1378 km). Four adolescents lived more than 500 km from our tertiary center. The 11 adolescents had a total of 334 in person visits (mean 30 ± 25) and 86 telemedicine visits (mean 8 ± 7). A ratio of 2:1 telemedicine to in-person visits was favored; with caregivers more in favor of remote care than adolescents. Qualitative analysis found that experiences with telemedicine were distinguished by consultation-specific factors and contextual factors. Contextual factors (travel/cost savings) were valued for telemedicine by adolescents and caregivers. Consultation-specific factors, such as the ability to show the doctor physical symptoms, were more valued during in-person consultations, especially by adolescents. The overall visit type preference was related to the nature of the consultation. For regular check-ups, and for adolescents with less complex needs, participants felt that telemedicine offered a comparable experience to in-person visits. Adolescents with more complex conditions preferred in-person visits. CONCLUSIONS: Indiscriminate transfer to chronic care predicated on mainly telemedicine approach is not compatible with user expressed attitudes (especially among adolescents). Accurately mapping models of care to these attitudes is an essential determinant of effective management and longer-term engagement with potentially life-long health challenges.

The relationship between coping styles and affective/behavioural symptoms among individuals with an acquired brain injury.

PRIMARY OBJECTIVE: To evaluate the impact of combined Axis I and II emotional profiles, demographic and psychosocial variables on coping responses in an Acquired Brain Injury (ABI) population using the Personality Assessment Inventory (PAI) and the Coping Response Inventory (CRI). RESEARCH DESIGN: This was a retrospective study examining the relationship between coping styles with affective, demographic and psychosocial variables using a multi-dimensional profile analysis. METHODS AND PROCEDURES: Participants completed the PAI and CRI during a regular clinical visit at the ABI Program (n = 100). Profile data was divided into seven established sub-types and analysed with coping responses. Traumatic (TBI; n = 78) and non-traumatic (n = 24) brain-injured individuals comprised the sample. MAIN OUTCOMES AND RESULTS: Previous findings were confirmed showing that highly symptomatic patients primarily use negative coping strategies. Also, affective symptoms, gender, relationship status, perceived stress and psychosocial supports mediate the use of different negative coping responses. Interesting, anxiety-based symptoms were associated with positive responses similar to asymptomatic ABI patients. CONCLUSIONS: Coping strategies adopted by brain-injured individuals are mediated by Axis I and II symptoms as well as psychosocial support, stress, marital status and gender. As a result, this has implications for developing treatment strategies.

Mobility assistive device utilization in a prospective study of patients with first-ever stroke.

OBJECTIVE: To estimate the extent to which clinical and functional features of stroke were related to the use of mobility assistive technology devices. DESIGN: Longitudinal study of quality of life after stroke. SETTING: Hospitals, rehabilitation centers, and universities in Ontario and Quebec. PARTICIPANTS: Subjects (N=316) with confirmed initial stroke were included in this analysis. Fifty-eight percent of the overall sample were men (n=184). The mean age of this sample at the time of the stroke +/- standard deviation was 65.3+/-15.3 years (range, 19-96y). One hundred thirty-five patients received a mobility assistive device poststroke, and 181 did not. INTERVENTION: Assistive devices for mobility (canes, walkers, wheelchairs). MAIN OUTCOME MEASURES: Assistive device use and mobility capacity. RESULTS: Mobility device nonusers were less physically disabled than device users on a variety of measures. Poor physical functioning but good cognition were reliably associated with mobility device use. Use of multiple mobility assistive devices was more often associated with poorer physical functioning than was single device use. For single device users, wheelchair use was predicted by cognition, functional independence, and stroke recovery. Cane users, compared with walker users, had better mobility and were less physically impaired by stroke. CONCLUSIONS: Patients were well matched to device type based on their mobility capacity. The findings of this study suggest that assistive device prescription-outcome relationships in stroke can be effectively and meaningfully modeled.