Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals.

Objectives: The objective was to characterize the variations in practice in the diagnosis and management of children admitted to hospitals from Canadian pediatric emergency departments (EDs) with suspected appendicitis, specifically the timing of surgical intervention, ED investigations, and management strategies.

Methods: Twelve sites participated in this retrospective health record review. Children aged 3 to 17 years admitted to the hospital with suspected appendicitis were eligible.

Infantile-onset saccade initiation delay (congenital ocular motor apraxia).

Infantile-onset saccade initiation delay, also known as congenital ocular motor apraxia, typically presents in early infancy with horizontal head thrusts once head control is achieved. Defective initiation of horizontal saccades and saccade hypometria with normal saccadic velocity are characteristic findings. Isolated impairment of vertical saccades is rare.

Toxic epidermal necrolysis and hemophagocytic lymphohistiocytosis: a case report and literature review.

Diagnostic criteria for hemophagocytic lymphohistiocytosis should be reviewed early in critically ill patients with toxic epidermal necrolysis, multisystem dysfunction, and a deteriorating clinical trajectory.

Foot-to-foot bioelectrical impedance accurately tracks direction of adiposity change in overweight and obese 7- to 13-year-old children.

Body composition measurements are valuable when evaluating pediatric obesity interventions. We hypothesized that foot-to-foot bioelectrical impedance analysis (BIA) will accurately track the direction of adiposity change, but not magnitude, in part due to differences in fat patterning. The purposes of this study were to examine the accuracy of body composition measurements of overweight and obese children over time using dual-energy x-ray absorptiometry (DXA) and BIA and to determine if BIA accuracy was affected by fat patterning.

Clinical imaging guidelines part 1: a proposal for uniform methodology.

Inappropriate imaging can lead to unnecessary medical radiologic exposures and cost and may not answer the clinical question. Imaging referral guidelines inform the justification of radiologic procedures and facilitate the choice of the best test first, but their acceptance by referrers, use, and value may be limited by shortcomings in the methodology of development. Focusing on common, essential elements of methodology will help guideline developers.

Impact of Ethnicity on Donor Search Results for Children Requiring Stem Cell Transplantation.

Hematopoietic stem cell transplantation (HSCT) can be curative for children with various malignant and nonmalignant conditions. Access to suitable unrelated living donors (ULDs) or unrelated cord blood (UCB) may be limited for certain ethnic backgrounds. We therefore determined the impact of ethnicity upon donor availability in a pediatric cohort referred for allogeneic HSCT to a single Canadian transplant center.

Redefining normal bone and mineral clinical biochemistry reference intervals for healthy infants in Canada.

Background: Few normative data exist for routine clinical chemistry in healthy term infants, that is, during a time of rapid development. Biochemical markers are significantly affected by these physiological changes and the lack of appropriate reference intervals may impede diagnostics in infants.

Objective: To define reference intervals for calcium, phosphate, creatinine, and alkaline phosphatase in infants from 1 to 12 months of age.

The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort.

Objective: To describe clinical outcomes of juvenile idiopathic arthritis (JIA) in a prospective inception cohort of children managed with contemporary treatments.

Methods: Children newly diagnosed with JIA at 16 Canadian paediatric rheumatology centres from 2005 to 2010 were included. Kaplan-Meier survival curves for each JIA category were used to estimate probability of ever attaining an active joint count of 0, inactive disease (no active joints, no extraarticular manifestations and a physician global assessment of disease activity <10 mm), disease remission (inactive disease >12 months after discontinuing treatment) and of receiving specific treatments.

Breath stacking in children with neuromuscular disorders.

Respiratory muscle weakness in neuromuscular disorders (NMD) can lead to shallow breathing and respiratory insufficiency over time. Children with NMD often cannot perform maneuvers to recruit lung volume. In adults, breath stacking with a mask and one-way valve can achieve significantly increased lung volumes.

Surveillance biopsies in children post-kidney transplant.

Surveillance biopsies are increasingly used in the post-transplant monitoring of pediatric renal allograft recipients. The main justification for this procedure is to diagnose early and presumably modifiable acute and chronic renal allograft injury. Pediatric recipients are theoretically at increased risk for subclinical renal allograft injury due to their relatively large adult-sized kidneys and their higher degree of immunological responsiveness.

Vaginal entrapment of bathwater: a source of extra-urethral incontinence.

This report presents 2 cases of females (a prepubertal and a pre-menopausal female) with dribbling "incontinence" caused by vaginal entrapment of bathwater. In the first case, an 8-year-old girl presented with a history of bothersome wetness of her underwear, noted mainly in the morning. History revealed that she bathed almost nightly.

Health care providers' perceptions of family presence during pediatric resuscitation.

Background: The Pediatric Intensive Care Unit (PICU) team strives to achieve the family-centred care philosophy consistent with the organization's vision and mission. In 2006, a team of nurses began exploration of the evidence on family presence during pediatric resuscitation with the primary goal to integrate this knowledge into practice. From the literature search, it was apparent there was limited published research, especially in a Canadian pediatric setting.

Spacelabs Innovative Project Award winner--2007. Solar system of safety.

In 2004, the pediatric intensive unit at the Winnipeg Children's Hospital began a journey into space, engaging in the evolving culture of safety emerging in Canada. This process started with the joining of the Canadian ICU Collaborative on Patient Safety, where the first project focused on decreasing catheter-related blood stream infections (CRBSIs). This single project created the impetus for the mission: 2007 Solar system of safety.

Diagnostic usefulness of graded exercise testing in pediatric supraventricular tachycardia.

Background: Episodic symptoms, often reported during exertion, complicate the assessment of suspected supraventricular tachycardia (SVT).

Objective: To examine the diagnostic sensitivity of graded exercise testing in young patients with documented SVT or ventricular preexcitation.

Methods: A single-centre retrospective review identified 53 patients (5.

Predictive value of clinical and EEG features in the diagnosis of stroke and hypoxic ischemic encephalopathy in neonates with seizures.

Background And Purpose: In neonates, the differentiation of stroke and hypoxic ischemic encephalopathy (HIE) is important. Neuroimaging presents technical challenges in unstable neonates, resulting in frequently delayed or missed diagnosis of stroke. Differentiating clinical and electroencephalographic (EEG) features would assist physicians in the timely diagnosis.