Development and implementation of a postgraduate medical education-wide initiative in quality improvement and patient safety.

BACKGROUND: Quality improvement and patient safety (QIPS) have been assigned a higher profile in CanMEDS 2015, CanMEDS-Family Medicine 2017 and new accreditation standards, prompting an initiative at Dalhousie University to create a vision for integrating QIPS into postgraduate medical education. OBJECTIVE: The purpose of this study is to describe the implementation of a QIPS strategy across residency education at Dalhousie University. METHODS: A QIPS task force was formed, and a literature review and needs assessment survey were completed. A needs assessment survey was distributed to all Dalhousie residency programme directors. 12 programme directors were interviewed individually to collect additional feedback. The results were used to develop a 'road map' of recommendations with a graduated timeline. RESULTS: A task force report was released in February 2018. 46 recommendations were developed with a timeframe and responsible party identified for each. Implementation of the QIPS strategy is underway, and evaluation and challenges faced will be described. CONCLUSIONS: We have developed a multiyear strategy that is available to provide guidance and support to all programmes in QIPS. The development and implementation of this QIPS framework may serve as a template for other institutions who seek to integrate these competencies into residency training.

Managing type 1 diabetes in school: Recommendations for policy and practice.

Diabetes requiring insulin is increasingly common and likely to impact students in most, if not all, schools. Diabetes and its complications have major personal, social and economic impact, and improved diabetes control reduces the risk of both short- and long-term complications. Evidence shows that more intensive management of diabetes - through frequent blood glucose monitoring, insulin administration with injections and/or insulin pumps, and careful attention to diet and exercise - leads to better control. Since children spend 30 to 35 hours per week at school, effectively managing their diabetes while there is integral to their short- and long-term health. The Canadian Paediatric Society and the Canadian Pediatric Endocrine Group recommend that minimum standards for supervision and care be established across Canada to support children and youth with type 1 diabetes in schools. These recommendations are derived from evidence-based clinical practice guidelines, with input from diabetes care providers from across Canada, and are consistent with the Canadian Diabetes Association's Guidelines for the Care of Students Living with Diabetes at School.

Chez les enfants, la présence d'un diabète nécessitant l'insuline pour traitement est de plus en plus fréquente. De fait, il est fort probable que la majorité des écoles canadiennes ait au moins un élève touché par cette maladie. Le diabète et ses complications ont des répercussions personnelles, sociales et économiques majeures. Cependant, une meilleure maîtrise du diabète réduit les risques de complications à court et long terme. Il a été démontré qu'une prise en charge plus intensive du diabète ­ par une surveillance régulière de la glycémie, l'administration d'insuline par injection ou pompe à insuline et une attention particulière à l'alimentation et à l'activité physique ­ en facilite la maîtrise. Comme les enfants passent de 30 à 35 heures par semaine à l'école, il est essentiel pour leur santé que la prise en charge de leur diabète y soit efficace. La Société canadienne de pédiatrie et le Groupe canadien d'endocrinologie pédiatrique recommandent d'établir des normes minimales pancanadiennes de supervision et de soins pour aider les enfants et les adolescents atteints de diabète de type 1 dans les écoles. Ces recommandations ont été inspirées de lignes directrices de pratique clinique fondées sur des données probantes et de la contribution des cliniciens du domaine des soins en diabète pédiatrique de tout le Canada. Elles respectent les Guidelines for the Care of Students Living with Diabetes at School [lignes directrices pour les soins aux élèves diabétiques à l'école] de l'Association canadienne du diabète.

Implementation of a resident-led patient safety curriculum.

The Royal College of Physicians and Surgeons of Canada has made Quality Improvement and Patient Safety (QIPS) a priority in residency education, however, implementation is limited by the heterogeneity of previously published curricula. We created a longitudinal resident-led patient safety (PS) curriculum using relatable, real-life PS incidents (PSIs) and an analysis framework.Implementation was feasible, well received by residents and demonstrated significant improvement in residents' PS knowledge,skills, and attitudes. Our curriculum built a culture of PS within a pediatric residency program, promoted engagement in QIPS practices early in training, and filled a gap in the current curriculum teaching.

Le Collège royal des médecins et chirurgiens du Canada a fait de la sécurité des patients et de l'amélioration de la qualité (SPAQ) une priorité dans la formation des résidents, mais l'atteinte de ces objectifs est limitée par l'hétérogénéité des programmes de formation existants. Nous avons co-construit avec des residents un programme de formation longitudinal sur la sécurité des patients (SP), à partir d'incidents réels et pertinents liés à la SP et d'un cadre d'analyse. Facile à réaliser et bien accueillie par les résidents, la formation a été suivie d'une amélioration marquée des connaissances, des compétences et des attitudes des résidents en matière de SP. Notre formation a permis de créer une culture de la SP au sein d'un programme de résidence en pédiatrie, de promouvoir l'adoption de pratiques qui favorisent la SPAQ dès le début de la residence et de combler ainsi une lacune des programmes actuels.

Unexpectedly high incidence of Kawasaki Disease in a Canadian Atlantic Province- an 11-year retrospective descriptive study.

BACKGROUND: Kawasaki Disease (KD) is the leading cause of acquired heart disease in children in developed countries with a variable incidence worldwide. Previous studies reported an unexpectedly high incidence of KD in the Canadian Atlantic Provinces. The goals of our study were to validate this finding in the province of Nova Scotia and to carefully review patients' characteristics and disease outcomes. METHODS: This was a retrospective review of all children < 16 years old from Nova Scotia diagnosed with KD between 2007-2018. Cases were identified using a combination of administrative and clinical databases. Clinical information was collected retrospectively by health record review using a standardized form. RESULTS: Between 2007-2018, 220 patients were diagnosed with KD; 61.4% and 23.2% met the criteria for complete and incomplete disease, respectively. The annual incidence was 29.6 per 100,000 children < 5 years. The male to female ratio was 1.3:1 and the median age was 3.6 years. All patients diagnosed with KD in the acute phase received intravenous immunoglobulin (IVIG); 23 (12%) were refractory to the first dose. Coronary artery aneurysms were found in 13 (6%) patients and one patient died with multiple giant aneurysms. CONCLUSION: We have confirmed an incidence of KD in our population which is higher than that reported in Europe and other regions of North America despite our small Asian population. The comprehensive method to capture patients may have contributed to the detection of the higher incidence. The role of local environmental and genetic factors also deserves further study. Increased attention to regional differences in the epidemiology of KD may improve our understanding of this important childhood vasculitis.

The relationship of sex and risk behaviours to students' use of school-based health centres in Cape Breton, Nova Scotia.

OBJECTIVE: Among other benefits, school-based health centres (SBHCs) are thought to provide opportunities to identify and help adolescents with risk-taking behaviours. The present study examined the use of SBHCs at three high schools in Cape Breton, Nova Scotia, to determine the extent to which SBHCs reach students at risk, and whether there are sex differences with respect to this reach. METHODS: Self-administered surveys of students in grades 10 to 12 at the three high schools were carried out in May 2006. RESULTS: The response rate was 70% of registered students. Boys were more often at risk than girls due to substance use, while girls were more often at risk due to sexual activity and suicidal thoughts. More girls visited SBHC nurses than boys (49% versus 10%; P<0.001). After adjusting for age, boys who saw a SBHC nurse were significantly more likely to engage in all risk-taking behaviours than boys who did not see a nurse; girls who saw a nurse engaged in most risk-taking behaviours significantly more often than girls who did not. However, no more than 22% of students with each specific risk behaviour used SBHCs to address those risks, with the exception of girls consulting for sexual health reasons, who made up 59% of all girls in the schools who reported being sexually active. CONCLUSIONS: Boys infrequently use SBHCs, and many at-risk students of both sexes do not use SBHCs. If the full potential for these SBHCs to help students with risk behaviours is to be realized, the need to increase reach to students is clear.

Measuring in support of early childhood development.

A child's early experiences and environments have a significant, measurable effect on later life trajectories of health and well-being. Each child's own world, especially parents and other caregivers, literally sculpts the brain and impacts stress pathways. Effective early childhood interventions exist that can improve adult and societal outcomes. In this statement, the Canadian Paediatric Society calls on federal and provincial/territorial governments to measure and monitor the developmental progress of children in Canada, which can vary widely among communities and demographic groups. The statement explores the objectives for collecting quality information about early child development, its determinants and long-term outcomes. It also examines four approaches to collecting population-based, person-specific and longitudinal data, both in young children and later in life. A key outcome of monitoring development is timely intervention. Linking individual data to the home and community levels is a critical step, so that communities and governments can monitor and take actions that support early child development.