Arthropod-borne disease in Canada: A clinician��s perspective from the ��Cold Zone��

Arthropod-borne diseases do not occur commonly in Canada. Nevertheless, Canadians run the risk of contracting certain infections within the country during arthropod season, as well as when travelling abroad. Therefore, it is important that clinicians are aware of the possible occurrence of arthropod-borne diseases, and consider them in their differential diagnoses. The present review is divided into two sections: arthropod-borne diseases or disease agents documented in Canada, and imported arthropod-borne diseases. The review also provides brief overviews of these diseases.     

Who was the very first teacher of paediatrics in Italy?

It has always been said that the first teachings of paediatrics in Italy were those of Dante Cervesato in Padua. However, documents indicate the historic groundlessness of such information. During the period after the unification of Italy and before Cervesato, teaching was carried out in Venice, Siena, Naples and Genoa. The first teaching post with a teaching hospital was founded in 1882 and appointed to Moisè Raffael Levi as a temporary professor following a national exam in Florence. Cervesato began lessons in May 1882, nevertheless was put in charge without a ward which was only assigned to him in 1889. He became temporary professor in 1885, 13 years after Levi. One cannot conclude without mentioning Aurelio Bianchi, Professor Levi's assistant, who had to abandon his university career in order to become head of the "Meyer" hospital in Florence due to the death of his predecessor.     

Which better predicts later outcome in fullterm infants: quality of general movements or neurological examination?

The qualitative assessment of general movements (GMs) has been shown to be a better predictor of neurological outcome than the traditional neurological examination in brain-damaged preterm infants. The aim of this study was to compare the results of the two techniques in term infants. Off-line assessment of GMs from videorecordings and neurological examinations were carried out, from birth till about 6 months of postterm age, in a group of 58 term infants, the majority of which were affected by mild to severe hypoxic-ischaemic encephalopathy. The agreement between the two techniques and their predictive power, with respect to the neurological outcome at 2 years, were evaluated for four age groups. The range of agreement between neurological and GM findings was between 78 and 83%. At all ages the results of GM observation correlated highly with the neurological outcome; their sensitivity and specificity with respect to outcome were consistently slightly superior to those of neurological examination. If infants normalize after an initial period of transient abnormalities, GMs normalize earlier than the neurological results.     

An audit of cancer diagnosis in a Canadian children��s hospital: Quality, timing and efficiency

BACKGROUND AND OBJECTIVE

The diagnosis of paediatric cancer requires multidisciplinary cooperation to achieve both a timely diagnosis and efficient resource use. The authors undertook a 12-month audit of paediatric cancer cases to assess BC’s Children’s Hospital’s (Vancouver, British Columbia) diagnostic process from the perspective of quality (timing and accuracy of diagnosis) and procedural efficiency, with an emphasis on the impact on resource use in the departments of radiology, pathology, anesthesia and surgery.

METHODS

Malignancies (excluding brain and cortical bone primary tumours, for which the preoperative diagnostic workup is often completed before admission) diagnosed between January 1 to December 31, 2003, were reviewed. Data collected included total outpatient versus inpatient procedures, number and timing of diagnostic procedures, general anesthesia (GA) requirements, and lag times from admission to biopsy to diagnosis during the initial hospitalization.

RESULTS

Fifty-four patients were identified. Only 10 patients (19%) had an outpatient diagnostic procedure. One hundred seventeen inpatient diagnostic procedures were performed, with only 50% occurring within regular working hours. Thirty-one per cent of patients required two or more procedural GAs during their initial hospital admission. The mean lag time to biopsy was 2.6 days and to a pathological diagnosis was 1.2 days.

CONCLUSIONS

Despite timeliness, the process of cancer diagnosis at BC Children’s Hospital requires hospital admission and a significant consumption of resources outside of regular working hours. Opportunities for improvement include maximizing outpatient workup, allocating oncology operating room time to increase the percentage of weekday procedures and improving interdisciplinary procedural coordination to reduce the GA requirements per patient.     

Implementation of the Canadian Paediatric Society’s hyperbilirubinemia guidelines: A survey of Ontario hospitals

INTRODUCTION:

In 2007, the Canadian Paediatric Society (CPS) published guidelines aimed at preventing severe hyperbilirubinemia.

OBJECTIVES:

To determine whether hospitals had implemented these guidelines; to investigate how guideline-recommended care is organized; and to understand the factors influencing guideline implementation.

METHODS:

The present study was an online survey conducted from December 2011 to May 2012 of all Ontario hospitals offering maternal-newborn services.

RESULTS:

A total of 97 of 100 eligible hospitals responded. Seventy-seven of the 97 (79%) respondents reported having implemented universal neonatal bilirubin screening. Among these hospitals, hospital-based postdischarge follow-up was reported more frequently than follow-up at community-based locations: hospital laboratory (n=40 [52%]), mother-baby care unit (n=32 [42%]), outpatient clinic (n=25 [33%]), primary care provider in community (n=19 [25%]) and community laboratory (n=8 [10%]). The CPS guidelines were the most frequently reported factor influencing implementation (n=74 [96%]).

DISCUSSION:

The survey provides valuable insight into the impact of a complex guideline in Canada’s largest province. There was heterogeneity in how hospitals organized services, but there was a notable trend toward hospital-based postdischarge care. The shift to hospital-based care runs counter to current health policy directions and highlights the lack of integration among health care sectors.

CONCLUSION:

The majority of Ontario hospitals implemented universal bilirubin screening following the release of the CPS guidelines. Further analysis is needed to determine the impact that the guidelines and the differences in implementation have had on clinical outcomes and the utilization of health services.     

Are the career choices of paediatric residents meeting the needs of academic centres in Canada?

BACKGROUND:

Responsibility for training paediatric medical subspecialists in Canada lies primarily with the 16 academic paediatric departments. There has been no mechanism to assess whether the number of residents in training will meet the needs of currently vacant positions and/or the predicted vacancies to be created by anticipated faculty retirement in the next five years across the different paediatric medical subspecialties.

HYPOTHESIS:

At the present time, the training of the paediatric physician is not linked with the current and future needs of the academic centres where the vast majority of these paediatric subspecialists are employed.

METHODS:

The academic paediatric workforce database of the Paediatric Chairs of Canada (PCC) for the surveys obtained in 2009/2010 were analyzed. Data included the number of physicians working in each subspecialty, the number of physicians 60 years of age or older, as well as the number of residents and their level of training.

RESULTS:

There are some paediatric subspecialties in which the actual number of trainees exceeds the currently predicted need (eg, cardiology, critical care, hematology-oncology, nephrology, neurology, emergency medicine and genetic-metabolic). On the other hand, for other specialties (eg, adolescent medicine, developmental paediatrics, gastroenterology and neonatology), assuming there is no significant change to selection patterns, an important gap will persist or appear between the need and the available human resources.

CONCLUSION:

The present analysis was the first attempt to link the clinical orientation of trainees with the needs of the academic centres where the vast majority of these paediatric subspecialists work.     

Risk compensation in children��s activities: A pilot study

BACKGROUND:

The intent of protective equipment (PE) in sports and leisure activities is to reduce injuries. However, some postulate that any safety measure prompts riskier behaviour, a phenomenon known as ‘risk homeostasis’ or ‘risk compensation.’ This study explores one approach to examining this in children. The rationale for this pilot study was to establish if children between six and 16 years old could answer questions about risk-taking sensibly and which questions, if any, could be eliminated; to establish the reliability of response; and to determine the numbers needed for a definitive study.

METHODS:

Sixty-three children with nonsevere injuries, ages six to 16 years, were interviewed while waiting to be seen at the Montreal Children’s Hospital emergency department. An interviewer administered a questionnaire comprising three sections. The first part only applied to those who were injured in an activity for which some form of PE was available (n=19). The second part examined customary risk-taking behaviour using the thrill and adventure seeking scales of a standardized questionnaire (Zuckerman) (n=63). The third section posed hypothetical questions about likely risk-taking when using PE to those who had engaged in such activities (n=58).

RESULTS:

The approach and questionnaire proved feasible with this age group. The responses suggest that children wearing PE were more likely to report increased risk-taking than those who did not wear PE. For most of the hypothetical questions, the majority also reported changes toward riskier behaviour when using PE. However, those wearing PE scored lower on the thrill and adventure seeking scale, suggesting that they are, by nature, less venturesome.

CONCLUSION:

The results indicate that risk compensation may modify the effectiveness of PE for children engaged in sports and leisure activities. Conversely, the findings also suggest that those wearing PE may be a cautious subgroup.     

Pulse polio immunization in Delhi—1995–96: A survey

A coverage evaluation survey of the campaign for mass Pulse Polio Immunization (PPI) on 9th December, 1995 and 20th January, 1996 in Delhi was carried out using the modified cluster sampling technique and a pre-structured proforma. Six-hundred-and-nine children of under-3 age group were covered in the survey. Overall coverage for both the doses was found to be 77% While coverage for 9th December dose was found to be 80%, it rose to 90.2% on 20th January, 1996. Coverage levels for male and female children were similar. Parental literacy was seen as a definite factor, positively affecting the coverage levels. Proportion of not covered under PPI was significantly higher in the 0–6 months age group. Television and health workers were found to be the main sources of awareness about PPI.