Publications by authors named "Mercedes Pilkington"
Article Synopsis
- The study focused on creating consensus recommendations for managing neonatal pain during surgery, emphasizing evidence-based strategies to enhance recovery and minimize opioid use.
- An international guideline development committee involved paediatric anaesthesiologists, surgeons, and ERAS experts in defining patient eligibility and selecting relevant pain management topics.
- Ultimately, the committee recommended using regular acetaminophen and considering locoregional analgesia, while noting a need for further research on non-opioid options for effective pain control in neonates.
Importance: Neonates requiring surgery are often cared for in neonatal intensive care units (NICUs). Despite a breadth of surgical pathology, neonates share many perioperative priorities that allow for the development of unit-wide evidence-based Enhanced Recovery After Surgery (ERAS) recommendations.
Observations: The guideline development committee included pediatric surgeons, anesthesiologists, neonatal nurses, and neonatologists in addition to ERAS content and methodology experts.
Introduction: Enhanced Recovery After Surgery (ERAS®) protocols require multidisciplinary team engagement from healthcare professionals (HCPs), where limited studies exist on neonatal ERAS®protocols. Therefore, we aimed to capture perceptions of HCPs on facilitation and implementation of the neonatal ERAS®guideline.
Methods: 10 neonates were recruited.
Introduction: Enhanced Recovery After Surgery (ERAS) guidelines are bundled evidence-informed recommendations implemented to improve quality and safety of perioperative care. This study aims to determine feasibility of NICU implementation of an ERAS Guideline for Intestinal Resection, describing clinical outcomes and adherence to recommendations following light-touch implementation.
Methods: Infants <28 days undergoing laparotomy for intestinal resection in a closed-NICU were prospectively enrolled.
Importance: Enhanced Recovery After Surgery (ERAS) guidelines and the World Health Organization Surgical Safety Checklist (SSC) are 2 well-established tools for optimizing patient outcomes perioperatively.
Objective: To integrate the 2 tools to facilitate key perioperative decision-making.
Evidence Review: Snowball sampling recruited international ERAS users from multiple clinical specialties.
Introduction: Disparities in surgical management have been documented across a range of disease processes. The objective of this study was to investigate sociodemographic disparities in young females undergoing excision of a breast mass.
Methods: A retrospective study of females aged 10-21 y who underwent surgery for a breast lesion across eleven pediatric hospitals from 2011 to 2016 was performed.
Objective: To describe work-related factors, pregnancy, and pregnancy outcomes in female surgeons is the objective of this study.
Background: Some data suggest surgeon workload may deter pregnancy and adversely affect pregnancy outcomes in female surgeons.
Methods: A cross-sectional, web-based survey was distributed via e-mail to members of the Society of Obstetrics and Gynaecologists of Canada and to surgical departments of 6 Canadian universities from October 2019 to January 2020.
Article Synopsis
- Intussusception is the leading cause of bowel obstruction in children aged 3 months to 6 years, and a study was conducted in Ontario, Canada to analyze its incidence from 1997 to 2016.
- The overall incidence of intussusception in children under 18 increased from 0.9 to 2.3 cases per 100,000 child years, with the highest rates found in infants aged 6-12 months.
- The study found a 5-16% annual increase in incidence among children aged 6 months to 5 years, while geographic variability and a high rate of readmission for recurrence (10.7%) were also noted.
Background: The objective of our study was to describe the workup, management, and outcomes of pediatric patients with breast masses undergoing operative intervention.
Materials And Methods: A retrospective cohort study was conducted of girls 10-21 y of age who underwent surgery for a breast mass across 11 children's hospitals from 2011 to 2016. Demographic and clinical characteristics were summarized.
Objectives: Describe changes in the diagnostic approach and treatment for pediatric intussusception over two decades.
Study Design: Administrative universal healthcare data were used to conduct a population-based cohort study of intussusception between January 1997 and December 2016 in Ontario, Canada. A validated case definition was used to identify all patients (<18 years) treated for intussusception in the province at community or tertiary care centers.
Article Synopsis
- A retrospective study in Ontario analyzed healthcare costs for children under 18 treated for intussusception between 2003-2016, examining the impact of non-surgical vs. surgical management on expenses.
- Non-surgical treatment costs were the lowest ($2467), while surgical treatment costs were the highest ($8863), with increased costs for failed non-surgical attempts rising significantly over the years.
- The study suggests that standardizing care to enhance non-surgical success and promote early discharge could lead to financial savings for the healthcare system.
Background: Intercostal cryoablation(IC) for pain management in children undergoing Nuss Procedure has been previously described. We evaluated postoperative outcomes following Modified Ravitch procedure for pectus disorders comparing IC to thoracic epidural(TE).
Materials And Methods: Single-center retrospective review of pediatric patients (age < 21) undergoing Modified Ravitch procedure (January 2015-March 2019) with either IC(9), or TE(20) analgesia.
Background: The practice of "cutting-away" from venoarterial extracorporeal life support (ECLS) and leaving indwelling heparinized cannulas prior to decannulation is controversial. This study aims to determine the safety and efficacy of this strategy in patients with congenital diaphragmatic hernia (CDH) who require ECLS.
Methods: A single-center retrospective review of electronic health records was performed on all patients with CDH who underwent elective ECLS decannulation between January 2014 and September 2018.
More children with congenital heart disease are surviving and require noncardiac surgery. A high-yield summary of congenital heart anatomy and pathophysiology is presented to contextualize these patients for surgeons. Preoperative planning including risk stratification, anesthetic management and timing of elective surgery are discussed.
View Article and Find Full Text PDFPurpose: Favorable surgical outcomes depend on timely access to care. This study quantifies these delays and explores caregiver barriers to access in a Ugandan facility.
Methods: An interviewer-facilitated survey was administered over 8months to consecutive pediatric surgical families at Mbarara Regional Referral Hospital (MRRH).
Unlabelled: NFkappaB is involved in several pathogenic mechanisms that are believed to underlie the complex regional pain syndrome (CRPS), including ischemia, inflammation and sensitization. Chronic postischemia pain (CPIP) has been developed as an animal model that mimics the symptoms of CRPS-I. The possible involvement of NFkappaB in CRPS-I was studied using CPIP rats.
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