An Integrated Rapid Response Model for Pediatric Patients Requiring In-Patient Medical Stabilization: Lessons Learned to Enable Regional Capacity Building.

There was an unprecedented surge in admissions for medical stabilization of pediatric patients with eating disorders during the COVID-19 pandemic in Ontario. Eleven hospitals established an integrated rapid response model to ensure timely in-patient access for these patients. This population was cared for in re-allocated community hospital beds as a result of engaging hospital leadership, strengthening partnerships, consulting experts, leveraging existing resources and developing regional bed access strategies.

Factors Associated With Early Computed Tomography Imaging in Children Hospitalized With Severe Orbital Infections.

Objective: We identified factors associated with computed tomographic (CT) imaging within 24 hours of emergency department (ED) presentation in hospitalized children with severe orbital infections.

Patients And Methods: A multicenter retrospective cohort study was conducted that included children aged 2 months to 18 years between 2009 and 2018 who were admitted to the hospital with severe orbital infections, including periorbital and orbital cellulitis. Multivariable modified Poisson regression was used to identify possible factors associated with receiving a CT scan within 24 hours of ED presentation.

Impact of Multiprofessional Radiotherapy Peer Review on Multidisciplinary Team Meeting Staging in Head and Neck Cancer.

Aims: Cancer staging is routinely done in a multidisciplinary team meeting (MDM). There is however no established quality assurance (QA) for MDM-recorded cancer staging. Conversely, radiotherapy peer review is a recommended QA process.

Postoperative Sinus Tract: A Rare Occurrence Following Laparoscopic Cholecystectomy.

A sinus tract is a rare clinical condition characterized by a blind-ended tubular structure extending from deeper tissues to the skin, commonly occurring postoperatively, especially after gastrointestinal surgeries. Its pathogenesis often involves the breakdown of fatty tissue, pyogenic infections, or the retention of foreign bodies such as surgical implants or sutures. One notable scenario includes sinus tract formation following laparoscopic cholecystectomy due to retained gallstones.

Identifying serious underlying diagnoses among patients with brief resolved unexplained events (BRUEs): a Canadian cohort study.

Objective: To describe the demographics and clinical outcomes of infants with brief resolved unexplained events (BRUE).

Design: A retrospective cohort study.

Setting: 11 centres within the Canadian Paediatric Inpatient Research Network.

Retroperitoneal Extension of a Fistula-in-Ano: A Case Report.

Fistula-in-ano and anorectal abscesses are commonly encountered in surgical departments, but their extension into the retroperitoneum and pelvis to form an extensive collection is rare. Here, we present the case of a 66-year-old diabetic male who presented with lower abdominal pain and fever for a day, with signs of sepsis. He had a simple fistula in the perianal region for the past 15 years.

Ileocecal Duplication Cyst Masked by Appendicitis: A Surgeon's Eternal Dilemma.

Alimentary tract duplications are uncommon abnormalities. They are mostly found in the terminal ileum, and most develop symptoms before the age of two. Abdominal mass, intestinal blockage, intussusception, rectal hemorrhage, and abdominal pain are possible presenting signs.

Parenteral versus enteral fluids for infants hospitalized with bronchiolitis: The PREFER shared decision-making prospective observational study protocol.

Introduction: Incorporating shared decision-making (SDM) with children and families in hospitals was a top priority identified by patients, caregivers, and clinicians. Bronchiolitis, a common and costly reason for hospitalization in children, is an exemplar condition to study SDM in hospitals. Internationally, clinical practice guidelines differ when recommending intravenous (IV or parenteral) or nasogastric (NG or enteral) fluids for hospitalized infants with bronchiolitis who are unsafe to be fed orally.

Global epidemiology of cannabis use disorders and its trend from 1990 to 2019: Benchmarking analysis of the global burden of disease study.

Introduction: Cannabis is one of the most widely used psychoactive substances globally, with an increasing trend in its legalization for both medical and recreational purposes in various countries. While cannabis offers potential therapeutic benefits, its regular use can lead to the development of Cannabis Use Disorders (CUDs). Understanding the epidemiology of CUDs is crucial in assessing the public health burden associated with cannabis use.

Association of empiric antibiotic selection and clinical outcomes in hospitalised children with severe orbital infections: a retrospective cohort study.

Objective: To determine the association of initial empiric antibiotic regimens with clinical outcomes in hospitalised children with severe orbital infections.

Design: Multi-centre observational cohort study using data from 2009 to 2018 clinical records.

Setting: Canadian children's hospitals (7) and community hospitals (3).

Small-Cell Carcinoma of the Gall Bladder: A Rare Tumor of the Gall Bladder.

Small-cell carcinoma (SCC) of the gallbladder is a rare and distinctive clinicopathological entity, characterized by its aggressive nature with early metastasis and a poor prognosis. We present a rare case of a 53-year-old female who came with a perforated gall bladder and was later diagnosed with SCC. This report details how the patient was managed preoperatively, intraoperatively, and postoperatively.

Oxygen Saturation Targets in Infants Hospitalized With Bronchiolitis: A Multicenter Cohort Study.

Objectives: To examine 2 hospital oxygen saturation target policies and clinical outcomes in infants hospitalized with bronchiolitis.

Methods: This multicenter cohort study used data collected from a randomized clinical trial of infants aged 4 weeks to 24 months, hospitalized with bronchiolitis at children's and community hospitals from 2016 to 2019. We modeled the association between hospital oxygen saturation target policy, either 90% while awake and 88% while asleep (90%/88%) or 90% while awake and asleep (90%/90%), and clinical outcomes.

De-implementing low-value continuous pulse oximetry practice in infants hospitalized with bronchiolitis: A multicentre qualitative study.

Background: Clinical trial evidence supports the routine use of intermittent pulse oximetry in stabilized infants hospitalized with bronchiolitis. However, continuous pulse oximetry use is common.

Objective: This study aimed to understand the barriers and facilitators to de-implement continuous pulse oximetry and implement intermittent pulse oximetry in infants hospitalized with stabilized bronchiolitis.

A Feeding Adequacy Scale for Children With Bronchiolitis: Prospective Multicenter Study.

Objectives: To determine the measurement properties of the Feeding Adequacy Scale (FAS) in young children hospitalized with bronchiolitis.

Methods: Multicenter cohort study of infants hospitalized with bronchiolitis at children's and community hospitals in Ontario, Canada. Caregivers and nurses completed the FAS, a 10-cm visual analog scale anchored by "not feeding at all" (score 0) and "feeding as when healthy" (score 10).

Abscess volume as a predictor of surgical intervention in children hospitalized with orbital cellulitis: A multicentre cohort study.

Importance: Orbital cellulitis with subperiosteal or orbital abscess can result in serious morbidity and mortality in children. Objective volume criterion measurement on cross-sectional imaging is a useful clinical tool to identify patients with abscess who may require surgical drainage.

Objective: To determine the predictive value of abscess volume and the optimal volume cut-point for surgical intervention.

Variation in the Management of Hospitalized Children With Orbital Cellulitis Over 10 Years.

Objectives: No previous study has examined the management of hospitalized children with orbital cellulitis at both children's and community hospitals across multiple sites in Canada. We describe variation and trends over time in diagnostic testing and imaging, adjunctive agents, empiric antibiotics, and surgical intervention in children hospitalized with orbital cellulitis.

Patients And Methods: Multicenter cohort study of 1579 children aged 2 months to 18 years with orbital cellulitis infections admitted to 10 hospitals from 2009 to 2018.

Cost-effectiveness of Intermittent vs Continuous Pulse Oximetry Monitoring in Infants Hospitalized With Stabilized Bronchiolitis.

Importance: Pulse oximetry is a noninvasive technology that is integral to the supportive care of hospitalized infants with bronchiolitis. A multicenter, randomized trial comparing the effectiveness of intermittent vs continuous pulse oximetry found similar length of hospital stay and safety outcomes, and greater nursing satisfaction, with intermittent monitoring.

Objectives: To evaluate the cost-effectiveness of intermittent vs continuous pulse oximetry in hospitalized infants with stabilized bronchiolitis.

Canadian infants presenting with Brief Resolved Unexplained Events (BRUEs) and validation of clinical prediction rules for risk stratification: a protocol for a multicentre, retrospective cohort study.

Introduction: Brief Resolved Unexplained Events (BRUEs) are a common presentation among infants. While most of these events are benign and self-limited, guidelines published by the American Academy of Pediatrics inaccurately identify many patients as higher-risk of a serious underlying aetiology (positive predictive value 5%). Recently, new clinical prediction rules have been derived to more accurately stratify patients.

Factors Associated with Surgery and Imaging Characteristics in Severe Orbital Infections.

Objectives: To evaluate risk factors associated with surgical intervention and subperiosteal/orbital abscess in hospitalized children with severe orbital infections.

Study Design: We conducted a multicenter cohort study of children 2 months to 18 years hospitalized with periorbital or orbital cellulitis from 2009 to 2018 at 10 hospitals in Canada. Clinical details were extracted, and patients were categorized as undergoing surgical or medical-only management.

An audit into the timing of dental extractions pre-head and neck radiotherapy and the prevalence of osteoradionecrosis.

Objective It is recommended that radiotherapy for head and neck cancer commences ten days post-dental extractions to reduce the risk of osteoradionecrosis (ORN) of the jaw. However, consideration must be given to patients' survival which might be compromised by delaying radiotherapy for these patients. The records of 154 patients receiving radiotherapy to the head and neck were retrospectively reviewed between July 2016 and August 2017, at Queen Alexandra Hospital in Portsmouth, to identify patients who have developed ORN, associated risk factors and the relative timings of dental extractions compared to the guidelines of the Royal College of Surgeons (RCS).

Systematic Review of Molecular Biomarkers Predictive of Resistance to CDK4/6 Inhibition in Metastatic Breast Cancer.

Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors have revolutionized the treatment of hormone-positive metastatic breast cancers (mBCs). They are currently established as standard therapies in combination with endocrine therapy as first- and second-line systemic treatment options for both endocrine-sensitive and endocrine-resistant mBC populations. In the first-line metastatic setting, the median progression-free survival for the three currently approved CDK4/6 inhibitors, palbociclib, ribociclib, and abemaciclib, with aromatase inhibitors is greater than 2 years (palbociclib 27.

Bladder and Bowel Dysfunction Network: Improving the Management of Pediatric Bladder and Bowel Dysfunction.

Unlabelled: Lower urinary tract symptoms with constipation characterize bladder and bowel dysfunction (BBD). Due to high referral volumes to hospital pediatric urology clinics and time-consuming appointments, wait times are prolonged. Initial management consists of behavioral modification strategies that could be accomplished by community pediatricians.

Intermittent vs Continuous Pulse Oximetry in Hospitalized Infants With Stabilized Bronchiolitis: A Randomized Clinical Trial.

Importance: There is low level of evidence and substantial practice variation regarding the use of intermittent or continuous monitoring in infants hospitalized with bronchiolitis.

Objective: To compare the effect of intermittent vs continuous pulse oximetry on clinical outcomes.

Design, Setting, And Participants: This multicenter, pragmatic randomized clinical trial included infants 4 weeks to 24 months of age who were hospitalized with bronchiolitis from November 1, 2016, to May 31, 2019, with or without supplemental oxygen after stabilization at community and children's hospitals in Ontario, Canada.