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Background Internationally, substance use recovery and healing is increasingly the focus of health and public policy and practice. Yet, what constitutes recovery and healing, and how it is understood and enacted among young people who use(d) drugs (YPWUD) has been largely underexplored. This commentary argues for a re-imagining of substance use recovery and healing by centering the understandings and lived experiences of YPWUD and their caregivers. Methods We draw on insights from a needs assessment conducted using qualitative methods with 38 youth (14 to 24 years of age) and 18 caregivers from across the province of British Columbia, Canada, including in Vancouver, Victoria, Kelowna, and Prince George. All activities were undertaken in collaboration with our team’s Youth Health Advisory Council, a group of 9 youth with lived experience of substance use and its various interventional responses. Findings We discuss key insights from the needs assessment, highlighting the urgent need for more nimble approaches to supporting youth recovery and healing that adapt to shifting definitions, goals, and timelines as well as transitions across various substance use treatment, recovery, and care contexts. Our needs assessment also highlighted the often overlooked but critical role of families and caregivers. By foregrounding youth perspectives and experiences – including engagements with diverse treatment, recovery, and care programs and complex dynamics with caregivers – we identify key priorities and actionable recommendations to reorient policy, practice, and research so that they are more youth- and caregiver-centered.

IntroductionParapneumonic effusion and empyema are common complications of paediatric pneumonia. Acceptable treatment modalities for large parapneumonic effusions include antibiotics alone or in conjunction with surgical interventions. Clear guidelines on the best treatment approach are lacking and mostly based on evidence prior to widespread pneumococcal conjugate 13-valent vaccination (PCV-13).Methods and analysisA living systematic review and network meta-analysis will be performed comparing the five treatment modalities: (1) antibiotics alone; (2) chest tube drainage without fibrinolytics; (3) chest tube drainage with fibrinolytics; (4) video-assisted thoracoscopic surgery and (5) open thoracotomy. The review protocol is reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Eligible studies are randomised controlled trials comparing any pair of interventions in paediatric patients with empyema or parapneumonic effusion. The following databases will be searched: Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, LILACS and Google Scholar. Citation screening and data extraction will be completed using a validated crowdsourcing methodology using InsightScope. To assess the risk of bias, we will use the revised Cochrane risk of bias tool for randomised trials. The primary outcome of the study is the length of stay. Secondary outcomes are (1) periprocedural complications and (2) need for re-intervention. A frequentist network meta-analysis design will be implemented with a random-effects model comparing different interventions. In a subgroup analysis, studies and patients will be stratified by the size of pleural effusion and the date of trial (pre/post-PCV-13). Eligible citations and available results will be uploaded to an online database, hosted on Open Science Framework. The database will be updated at least every 4 months with any newly published research.Ethics and disseminationNo ethics review is required for this study. Results will be published in a peer-reviewed journal. Data will be available as part of an online database summarising the evidence of this living systematic review.PROSPERO registrationPending peer review.

Introduction/Objectives: Exposure to adverse social determinants of health (SDoH) in childhood is associated with poorer long-term health outcomes. Within structurally marginalized populations, there are disproportionately high rates of developmentally vulnerable children. The RICHER (Responsive, Intersectoral, Child and Community Health, Education and Research) social pediatric model was designed to increase access to care in marginalized neighborhoods. The purpose of this study was to describe the children and youth engaged with the RICHER model of service and characterize the needs of the population. Methods: A retrospective chart review was conducted on children and youth who accessed primary care services through the program between January 1, 2018 and April 30, 2021. Basic descriptive data analysis was done using Stata v15.1. Results: A total of 210 charts were reviewed. The mean age in years at initial assessment was 6.32. Patients most commonly identified their race/ethnicity as Indigenous (33%) and 15% were recent newcomers to Canada. Evidence of at least 1 adverse SDoH was noted in 41% of charts; the most common included material poverty (34%), food insecurity (11%), and child welfare involvement (20%). The median number of diagnoses per patient was 4. The most frequently documented diagnoses were neurodevelopmental disorders (50%) including developmental delay (39%), ADHD (32%), and learning disability (26%). The program referred 72% of patients to general pediatricians and/or other subspecialists; 34% were referred for tertiary neuropsychological assessments and 35% for mental health services. Conclusions: Our data suggests that this low-barrier, place-based primary care RICHER model was able to reach a medically, developmentally, and socially complex population living in disenfranchised urban neighborhoods. Half of the patients identified in our review had neurodevelopmental concerns and a third had mental health concerns, in contrast to an estimated 17% prevalence for mental health, behavioral, or developmental disorders in North American general pediatric aged populations. This highlights the impact adverse SDoH can have on child health and the importance of working with community partners to identify developmentally vulnerable children and support place-based programs in connecting with children who may be missed, overlooked, or disadvantaged through traditional models of care.

Background. In the fall of 2014, a North American outbreak of enterovirus D68 resulted in a significant number of pediatric hospital admissions for respiratory illness throughout North America. This study characterized the clinical presentation and risk factors for a severe clinical course in children admitted to British Columbia Children’s Hospital during the 2014 outbreak. Methods. Retrospective chart review of patients with confirmed EV-D68 infection admitted to BCCH with respiratory symptoms in the fall of 2014. Past medical history, clinical presentation, management, and course in hospital was collected and analyzed using descriptive statistics. Comparison was made between those that did and did not require ICU admission to identify risk factors. Results. Thirty-four patients were included (median age 7.5 years). Fifty-three percent of children had a prior history of wheeze, 32% had other preexisting medical comorbidities, and 15% were previously healthy. Ten children (29%) were admitted to the pediatric intensive care unit. The presence of complex medical conditions (excluding wheezing) ( P = 0.03 ) and copathogens was associated with PICU admission ( P = 0.02 ). Conclusions. EV-D68 infection resulted in severe, prolonged presentations of asthma-like illness in the hospitalized pediatric population. Patients with a prior history of wheeze and preexisting medical comorbidities appear to be most severely affected, but the virus can also cause wheezing in previously well children.

Background Canadian paediatric residents provide care to many families with non-English or French language preferences (NEFLP). Lack of communication in a family’s preferred language is inequitable and results in inferior care. Professional medical interpreters offer a route to enhanced understanding and safety. There is no data available about Canadian paediatric residents’ use of interpreters, making it difficult to identify gaps in practice or develop targeted interventions to improve patient experience. Objectives An anonymous, 19-item survey (REDCap) was designed to evaluate: (1) interpreter services available in paediatric training centers; (2) resident perception of their ease of access, utility, and value; and (3) barriers and drivers to interpreter use. This survey represents the first collection of data from Canadian paediatric residents about translator services. Design/Methods Eligible participants included all paediatric residents enrolled in an accredited Canadian paediatric training program. The survey was distributed by email and available for a three-month period. This project was reviewed and considered within the category of quality improvement and thus exempt from formal review by the hospital ethics committee. Descriptive statistics were performed in STATA v15.1. Results 122 residents (approximately 19% of eligible participants) responded. Approximately 40% reported no previous training in interpreter use, and 60% desired more training. Interpreter services are widely available but remain underused in a variety of clinical situations: interpreters are most often used during informed consent (98% ‘mostly’ or ‘always’), family meetings (97%), and history-taking (86%), and least often during physical examinations (41%) and bedside rounds (38%). Residents are more likely to use an interpreter if access is easy (97% ‘more likely’ or ‘likely’) or if there is extra time for the encounter (78%). Most residents (85%) felt they provide better care to patients who share their primary language (English or French), compared with families who prefer other languages. Conclusion Residents are more confident in their clinical and communication skills when working with families who share their primary language compared with NEFLP families, even when an interpreter is present. Our findings suggest that residents lack the training and confidence to provide equal care to families with varying language preferences. Paediatric training programs should develop curriculum content that not only targets safe and effective interpreter use, but also reviews non-spoken aspects of cultural awareness and safety.

Abstract Background Adverse Childhood Experiences (ACEs) are a group of early life events that lead to toxic stress and adverse adult health outcomes. Screening for ACEs can be challenging due to sensitivity and re-traumatization. There is a paucity of evidence regarding whether other social determinants of health (SDoH) might be independent predictors of an ACE score >=4. Likewise, no effective prediction rule exists for an elevated ACE score based on SDoH in children. Objectives 1) Identify independent predictors of elevated ACE score from commonly screened SDoH. 2) Derive a clinical prediction rule based on the available data. Design/Methods Data were drawn from a longitudinal quality improvement SDoH study in pediatric surgical clinics at a provincial children’s hospital. Primary outcome of interest was an ACE score >=4. Multivariable logistic regression was utilized to identify independent predictors among other SDoH. Prediction methods and ROC analyses were completed to derive a prediction rule. Results 515 respondents answered ACE screening; 63 (12.2%) reported >=4 ACEs. SDoH that were strong independent predictors of ACE score >=4 included poverty (OR 2.34, 95% CI 1.19-4.91), parental education (OR 2.76, 95% CI 1.17-6.54), and household income (OR 2.17, 95% CI 1.09-4.32). Housing status, Indigenous status, and disability status were not associated with elevated ACE score. A clinical prediction rule derived using four SDoH questions with a cut-off score of 1 had 96.67% sensitivity but only 21.54% specificity for an ACE score >=4 (AROC 0.75, 95% CI 0.69-0.81). Conclusion Several adverse SDoH were identified as independent predictors of an ACE score >=4 in children. A clinical prediction rule based on SDoH screening was sensitive but poorly specific for ACE >=4. Further research is required.

Background Toxic drug supply is a public health emergency in Canada. The syndemic impact of Covid-19 has exacerbated the adverse outcomes of overdose, driving up mortality rates. Despite the fact that opioid use disorder is predominantly viewed as an adult issue, an increasing number of youth in Canada experience severe-life threatening overdose; it is the leading cause of death in youth ages 10-18 in Western Canada. Epidemiologic data related to this population remains limited. 1.Objectives: To determine the minimum incidence of children and adolescents presenting with severe or life-threatening opioid, stimulant, and sedative exposure among youth presenting to Canadian paediatricians and paediatric subspecialists. 2.To describe the treatment and services available for youth presenting with substance use to paediatric care in Canada. Design/Methods A one-time cross-sectional survey of Canadian paediatricians and paediatric subspecialists using the Canadian Paediatric Surveillance System (CPSP) was conducted in the Spring of 2022. A population denominator of 2,900,866 was selected based on Statistics Canada census data for children and youth 12-18 in 2021. Data were analyzed using Stata v15.1. Results 1027 respondents (response rate: 37%) completed the survey, of whom 934 (90.9%) reported providing care to children and youth 12 years and above. 115 (12.3%) respondents indicated managing a youth with severe or life-threatening substance use in the prior 24 months. Most providers operated in urban settings (n=95, 84.8%), but there were cases reported in suburban (n=9, 8.0%) and rural/remote (n=8, 7.1%) environments as well. Calculated minimum cumulative incidence per 100,000/year were: opioid overdose 2.94; opioid use requiring pharmacotherapy 1.69; stimulant toxicity 3.22; and sedative toxicity 3.1 (Table 1). Respondents also reported service availability for youth substance use. Respondent awareness of the availability of overdose-related services was high for outpatient mental health services (85.4% for 12 to15-year-olds, 86.1% for 16 to18-year-olds), but poor to moderate (25.3%-53.1%) for all other surveyed services, including inpatient stabilization and intensive outpatient management. Conclusion Paediatricians and paediatric subspecialists interface significantly with youth experiencing severe substance use and overdose. The minimum calculated incidence rates provided are significant and concerning at the population level, despite excluding youth that do not seek physician care after overdose. Paediatric providers have limited awareness of service availability for youth that use substances. Further studies and knowledge translation are required.

Background Many individuals living in rural and remote communities are required to travel to urban centres to receive essential health care. These experiences may be especially complex for children and their families. Despite this, there is a lack of available literature on the experiences of children and families travelling to receive care at tertiary paediatric hospitals in Canada, specifically regarding associated costs and psychosocial impacts. 1.Objectives: Analyze tertiary hospital-based administrative data to quantify the number of admissions and length-of-stay for families living > 50 km from the hospital. 2.Describe the costs and psychosocial impacts of hospitalization on families living > 50 km from the hospital. Design/Methods Ethics approval was obtained. Family partners were involved in all aspects of the study design. We obtained a de-identified data set describing the length of stay and home community of paediatric patients admitted to our paediatrics unit. Descriptive statistics were produced to determine the relevant study population and inform subsequent data analyses. A cross-sectional survey was distributed to interested caregivers admitted to our paediatrics team. Participants were offered a $20 gift card as remuneration. The survey included optional questions to assess participant demographics, costs associated with hospitalization, and subjective stress levels. Descriptive statistics were reported. Results Administrative data analysis described 2,758 admissions to a paediatric tertiary hospital from January 1, 2021 to December 31, 2021. Patients from rural and remote communities were 9.54% of total admissions. Regression models found a strong statistical relationship between length of stay and distance from the tertiary centre (Pearson chi2 coefficient 58.9, p < 0.001). A total of 39 caregivers filled out the cross-sectional survey. 75% (n=29) of participants were from local communities and 25% (n=10) were from rural and remote communities. 82% (n=32) of hospital stays were unplanned. 54% (n=21) of participants paid out-of-pocket transportation costs and 13% (n=5) paid out-of-pocket accommodation costs. 82% (n=32) of participants had co-travellers. 20% (n=8) of participants reported difficulty paying for hospital-associated costs and 10% (n=4) had to borrow money to do so. Conclusion To our knowledge, this study is the first to look at the psychological and socioeconomic barriers facing families travelling to a tertiary paediatric hospital in Canada. Patients from outside the local area had increased odds of longer length of stay and participants described a variety of stressors associated with hospitalization. We hope to translate this data into evidence-based interventions to better support these families.

Abstract Background Canada’s expansive geography has implications for children and their families seeking tertiary paediatric care. There is minimal literature describing their experiences, particularly challenges associated with receiving inpatient care. This qualitative study builds on previous work that captured out-of-pocket costs and stress levels facing families while admitted to our hospital. Objectives Gather an in-depth understanding of family experiences through exploring gaps in current approaches and supports received 2) Generate potential patient-centred solutions to challenges identified Design/Methods Ethics approval was obtained. Family partners were involved in all aspects of study design. Qualitative descriptive methodology was adopted to allow for in-depth exploration of family experiences. Semi-structured interviews explored the above objectives. Participants were families that travelled more than 50 km to receive inpatient care under General Paediatrics at a tertiary hospital in Canada within 1 year of when the interview was conducted. In addition, families were purposively recruited through collaboration with community paediatricians until theoretical saturation was reached. Interviews were transcribed verbatim, de-identified, and analyzed for common themes using descriptive analysis in NVivo software. Results Between June and October 2023, 16 caregivers participated in our study. The key themes identified were in the following categories: navigating the unknown, bridging the gaps for far away families through equitable resources, and the role of self-advocacy. Families spoke to the overwhelm they faced when being admitted to our centre. For many, it was their first time in our city and the costs associated with being in this city were significant. They identified key gaps in resources and supports, such as knowledge of medical teams, difficulties with eligibility requirements and reimbursement, and inadequate availability of resources after-hours and on weekends. Self-advocacy was important to all participants and innovative solutions were proposed, such as knowledge exchange facilitated by caregivers with lived experience and caregiver-facilitated trainings for providers. Conclusion This qualitative study highlights the unique challenges facing families traveling significant distances to receive essential healthcare at a tertiary paediatric hospital in Canada. While significant gaps in resources exist, participants suggested innovative, patient-centred, equitable strategies to bridge these gaps. We plan to partner with patient partners to translate this data into evidence-based interventions to support these families at our institution.