Congratulations to Jenna on receiving a BC Children’s Hospital Research Institute Evidence to Innovation Summer Studentship

SESSION #8 Poster #71

Laura Seyler

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia | Supervisor: Kirk Schultz

Impact of Puberty on the Biology and Development of Chronic Graft-versus-Host Disease after Stem Cell Transplantation

Laura Seyler, Kirk Schultz

Background: Chronic Graft-versus-Host Disease (cGvHD) occurring after stem cell transplantation (SCT) is caused by an immune-mediated rejection of the recipient by the donor immune system. cGvHD is the primary non-malignant complication after SCT, involving and potentially lifelong chronic inflammation, dysregulated immunity, aberrant tissue repair, and fibrosis. It has been well established that pediatric recipients of SCT exhibit lower incidences of cGvHD compared to adults. Previous investigations into the influence of recipient age on cGvHD biology have unveiled disparities in the immune profiles of prepubertal children compared to adults, suggesting that post pubertal children exhibit profiles more closely aligned with adults. This difference is due either to an age-related decrease in thymic function or a surge of sex hormones during puberty may altering the biology of cGvHD. In the analyses on the large (N=302) pediatric multicenter ABLE study database that showed the impact of puberty, we “estimated” the onset of puberty by utilizing the mean age of the onset of Tanner stage 2 based on Tanner staging tables.

Purpose: Because clinical Tanner staging is not available from the ABLE database, we proposed to investigate whether the accuracy of the estimated onset of puberty by evaluating sex hormone measurement pre stem cell transplantation to accomplish this, archived plasma patient samples obtained before the start of the transplant from the ABLE cohort (N = 165) were analyzed using enzyme-linked immunosorbent assay (ELISA) to determine hormone levels. By completing a more definitive measurement to the onset of puberty by determining hormonal levels we can determine the accuracy of previous estimates in the ABLE studies.

Methods: Competitive ELISA techniques quantitatively measure testosterone or estradiol levels in plasma samples obtained. A microplate is precoated with the hormone, and a labeled antigen will be introduced with the patient sample. The capture antibody will selectively bind to the target hormone antigen, and unbound components will be removed through washing. An enzymatic reaction triggered by a substrate will generate a measurable signal, inversely proportional to the hormone concentration. The results will be compared against a standard curve to accurately quantify hormone levels.

Results: Graphical analysis suggests that estimating hormone levels in male patients should rely on either accurate clinical Tanner staging information or measurement of testosterone levels. However, in the case of female patients, the results of hormonal measurement do not appear to be accurate and clinical tanner stages is optimal.

Conclusion: Because of the variability of the hormonal levels, possibly due the inflammatory environ in the peri-transplant setting in females, accurate clinical Tanner staging is the optimal approach to evaluate the onset of puberty in future studies.

SESSION #9: CLINICAL

Moderator:

Katelynn Boerner

Participants:

Eduardo Sutherland

Zoe Kore

1:30 –3:00 PM

In-Person: Chieng

Family Atrium

Marta Karpinski

Rachel Lai

Valerie Swanston

Ty Sideroff

Alexander Stolz

Zoe Kortje

Kyle Ma

SESSION #9 Poster #72

Eduardo Sutherland

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Master’s Student, University of British Columbia | Supervisor: Anton Chau

Duration of Urinary Catheterization After Cesarean Deliveries –A Retrospective Cohort Study

Eduardo Sutherland, Thomas Yang, Anton Chau

Background: An indwelling urinary catheter is routinely placed to prevent over-distension of the bladder in women having cesarean birth under neuraxial anesthesia. The urinary catheter often remains in place during the postpartum period because there is inhibition of ambulation and spontaneous micturition from the neuraxial local anesthetic and opioids administered. With an increasing focus on enhanced postpartum recovery, the Society for Obstetric Anesthesia and Perinatology (SOAP) guideline recommends that removal of urinary catheter at 6-12 hours postpartum can promote ambulation, decrease incidence of urinary tract infections, and reduce urethral pain. The purpose of this study is to determine the current duration of urinary catheterization at BC Women’s hospital following cesarean deliveries. We hypothesized that the current duration of urinary catheterization is significantly greater than what is recommended by the SOAP guideline.

Methods: This study was deemed a quality improvement project and ethics committee review was not required. All pregnant patients undergoing a scheduled or unscheduled cesarean delivery at BC Women’s Hospital in July 2023 were included. Data on the time of neuraxial anesthesia, urgency of procedure, time of delivery, time of recovery of hip flexion, time of ambulation and time of urinary catheter removal were retrospectively collected from the electronic medical record. The primary outcome was the mean duration of urinary catheterization stratified by anesthetic techniques analyzed by unpaired t-test. Secondary outcome was the mean time to recovery of hip flexion and ambulation and the relationship between duration of urinary catheterization with these covariates analyzed using a multivariable linear regression model.

Results: To date, a total of 73 patients were included. The mean(SD) duration of urinary catheterization was 19.2 (4.7) h. When stratified for anesthetic technique, those who received spinal anesthesia had a significantly shorter mean duration of urinary catheterization compared to epidural anesthesia (18.7 h vs. 21.6 h, p = 0.004). The mean (SD) time to hip flexion recovery and ambulation were 5.1 (2.2) h and 14.6 (6.5) h, respectively. There was no significant relationship between the duration of urinary catheterization duration with any of the time variables.

Conclusions: The current duration of urinary catheterization after cesarean delivery at BC Women’s is significantly longer than what is recommended by national society guidelines. The urinary catheter remains in place beyond the time for recovery of hip flexion strengths and ability to ambulate. The next step is to survey the nursing practice to determine the barriers contributing to this delay in catheter removal.

SESSION #9 Poster #73

Zoe Kore

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Medical Student, University of British Columbia | Supervisor: Sally Hynes

Child Life for Children with Burns: Impact on Patient Experience

Zoe Kore, Rebecca Courtemanche, Young Ji Tuen, Jackie Nixon, Gloria Kwong, Sally Hynes

Background: Child Life Specialists (CLS) apply evidence-based psychosocial interventions to improve coping skills in pediatric patients undergoing medical procedures. They provide age-appropriate preparation, procedural support, and education to children and families. CLS support is particularly relevant in the context of burn wound care, as children with burns experience high levels of pain and distress. This quality improvement project aims to estimate the effect of the introduction of CLS support on patient experience for children receiving burn wound care at the BC Children’s Hospital (BCCH) Medical Day Unit (MDU).

Methods: This project is an observational, survey-based study. The first phase involves standard care, while the second includes CLS support. Following consent, surveys about patient experience are administered to children, parents, nursing staff, plastic surgeons, and the CLS. Procedural pain is measured using the Wong-Baker Faces Pain Scale (0-10). Procedural anxiety for children is assessed with the Venham Picture Test (0-8), while observational reports are scored using Venham’s Anxiety Rating Scale (0-5). Data are obtained from patients’ medical charts regarding burn characteristics and other relevant clinical information. Data were analyzed descriptively for all visits, and by visits with and without a CLS.

Preliminary Results: Eighteen children (mean age=6.38 years) have been recruited to date. Of the 36 total MDU visits, 7 involved CLS. For all visits, mean procedural pain scores were 3.81/10, 2.71/10, and 2.59/10; mean procedural anxiety scores were 1.76/8, 0.97/5, and 1.19/5, as reported by the child, parent, and staff, respectively. When a CLS was present, children reported less pain (-3.6) and higher anxiety (+1.1). Pain and anxiety scores reported by parents and staff were similar (mean differences <1).

Conclusion: While a larger sample size and a more robust statistical analysis are necessary to estimate the effect of CLS, preliminary feedback suggests this support is valued by parents and staff and improves patients’ coping skills during burn wound care. Enhanced coping skills may build children’s self-confidence when undergoing medical procedures and promote positive care experiences for patients, families, and the healthcare team.

Congratulations to Zoe on receiving a BC Children’s Hospital Research Institute Summer Studentship

SESSION #9 Poster #74

Marta Karpinski

Medical Student, University of Toronto | Supervisor: Jugpal Arneja

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Quality of Life after Surgery for Adolescent Gynecomastia: Preliminary Results

Marta

Karpinski, Young Ji Tuen, Rebecca Courtemanche, Jugpal Arneja

Background: Adolescent gynecomastia has detrimental impacts on patients’ psychosocial well-being. Surgical intervention for gynecomastia has been shown to significantly improve patients’ quality-of-life. However, to date, the impact of gynecomastia surgery in adolescents has only been assessed using generic quality-of-life scales, which may not sensitively capture important issues pertaining to the chest. The purpose of this study is to assess patients’ postoperative quality-of-life using a patient-reported outcome measure specific for body contouring procedures, and to identify patient and treatment factors associated with quality-of-life scores.

Methods: Patients were recruited from the senior author’s (JA) clinical practice at BC Children’s Hospital. Adolescent patients undergoing surgical treatment for Simon Grade I, IIa, or IIb gynecomastia from May 2009–November 2022 were eligible for inclusion. Eligible patients were invited to participate in the study via post mail and telephone call. Patients agreeing to participate completed the BODY-Q Satisfaction with Chest and Psychological Function scales, either on an online platform or over the phone, as per the participants’ preference. Raw scores were summed and converted into Rasch transformed scores (scale 0-100), and were averaged. Chart review was also performed to collect information on BMI, Simon Grade, post-operative complications, and revision procedures.

Results: Of the 79 patients invited to participate in the study, 26 (32.9%) completed the questionnaire. At the time of survey completion, the average age of participants was 23.5 years, and average BMI was 27.1. The median score on the Satisfaction with Chest scale was 70 (IQR, 55.5-100), and 73% of patients reported being “very satisfied” with the appearance of their surgical scars. The median score on the Psychological Function scale was 72.5 (IQR, 56.5-92). The average time from surgery to survey completion was 6.6 years. BMI, Simon Grade, post-operative complications and revision procedures were not significant predictors of satisfaction and psychological function scores.

Conclusion: This study shows that patients who underwent surgery for gynecomastia report good satisfaction with chest appearance and psychological function, with BODY-Q scores higher than those reported in the general population (54 and 61.14, respectively). The results of this study may have an important role in destigmatizing gynecomastia surgery for adolescents.

Congratulations

SESSION #9 Poster #75

Rachel Lai

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Master’s Student, University of British Columbia | Supervisor: Faizal Haji

Creating a Database to track the Natural History and Surgical Outcomes of Pediatric Patients with Spinal Dysraphism Followed in the British Columbia Children’s Hospital’s Spinal Cord Clinic

Rachel Lai, Belinda Dundon, Mark Williamson, Faizal Haji

Background: Spinal dysraphism in the pediatric population consists of a heterogeneous collection of different pathologies. This makes surgical decision making in this population challenging and complex. In open spinal dysraphism (e.g. myelomeningocele), the cord is directly exposed to the outside environment, requiring surgical intervention in utero or within days of life and potentially requiring management of associated complications (e.g. hydrocephalus and hindbrain herniation). Conversely, closed spinal dysraphisms involve the cord covered by other normal mesenchymal elements, and can include various pathologies (e.g. lipomyelomeningocele, terminal myelocystocele, limited dorsal myeloschisis, thickened/fatty filum terminale, split cord malformations, and caudal regression syndrome), which may remain asymptomatic or cause tethering of the spinal cord, with subsequent neurological deterioration. While it is likely that each of the aforementioned pathologies have distinct natural histories and potential morbidity associated with surgical correction, currently data related to these issues is scarce. This makes surgical decision making challenging, complex, and subject to surgeon or center preference. To overcome these challenges, we have created a new longitudinal dataset that captures the natural history, decision making process, and surgical outcomes of children with spinal dysraphism followed in the BC Children’s Hospital’s (BCCH) Spinal Cord Clinic (SCC).

Methods: The database utilizes REDCap to house the patient visit entries and is divided into the different specialties (neurosurgery, urology, orthopedics, physiatry, etc.) that follow the patient in the SCC. Data are extracted retrospectively from SCC joint reports (for patient visits prior to June 2023) and prospectively during patient visits (June 2023 onward). The neurosurgery domain of the dataset looks at multiple variables , including the type of spinal dysraphism, symptoms of cord tethering (neurological, urological and/or orthopedic), the Spina Bifida Neurological Scales (SBNS) score, changes on cranial or spinal imaging, and surgical interventions (e.g. cord detethering) and their outcomes.

Significance: We hope that the creation and implementation of this longitudinal dataset will better inform local surgical decision making for children with spinal dysraphism who present to the SCC. Once successfully pilot tested with the BCCH-SCC cohort, we plan to expand this database into a national and/or international prospective registry, from which larger scale studies to to identify risk factors for neurological deterioration and factors influencing outcome from surgical intervention in this population can be conducted.

SESSION #9 Poster #76

Valerie Swanston

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Medical Student, University of British Columbia | Supervisor: Jonathan Rayment

Assessing the safety and efficacy of home-collected airway microbiological samples in children with cystic fibrosis at BC Children’s Hospital

Valerie Swanston, Jonathan Rayment

Background: Lung disease caused by chronic infection and inflammation is the prominent source of morbidity and mortality in people with cystic fibrosis (CF). Current guidelines recommend at least quarterly airway microbiological surveillance, traditionally performed in clinic with sputum collection or airway swabs. During the coronavirus disease 19 (COVID19) pandemic, restrictions on in-person clinic visits resulted in reduced frequency of airway microbiological sample collection. There was a concern that virulent organisms could be missed in the CF population at BC Children’s Hospital (BCCH). In response, we developed a home culture program whereby kits containing sputum containers and airway swabs were mailed to the families of CF patients and parents were coached in collecting samples over Zoom. The clinic continues to use this technique for virtual appointments and for sample collection in the case of increased respiratory symptoms. However, the quantitative results of the samples collected as part of this initiative have not been assessed.

Methods: This is a retrospective quality improvement analysis of all children receiving care at the CF clinic at BCCH. Culture data was derived from the Sunset microbiological database at BCCH and clinical information was retrospectively collected from patient charts. Our outcomes of interest include (1) to characterize the frequency of home screening versus in-clinic screening, (2) to investigate the positivity rates of different pathogens in both screening methods, and (3) to compare the percentage of sampling methods used by home vs in-clinic screening.

Preliminary Results: Included in our analyses are 2853 culture results from respiratory samples collected between January 1st, 2019, to May 16th, 2023. Of these, 2086 were collected by healthcare providers at BCCH, 566 were collected by parents and/or caregivers in patients’ homes, and 201 were collected by healthcare providers at community outreach clinics. Overall positivity rates of all pathogens was higher in home-collected cultures compared to in-clinic cultures (64.7% versus 42.8%).

Discussion: The results of this study have an opportunity to directly impact the care of children with CF at BCCH. If home collection appears to provide microbiological data similar to that obtained with in-person collection, we may consider revisiting our practice in clinic.

Congratulations to Valerie on receiving a BC Children’s Hospital Research Institute

Childhood Diseases Summer Studentship Summer Studentship

SESSION #9 Poster #77

Ty Sideroff

Watch In-Person:

Thursday, July 27 | 1:30 - 3:00 pm

Chieng Family Atrium, BCCHR

Undergraduate Student, University of British Columbia – Okanagan | Supervisor: Christine Voss

A Longitudinal Study of Physical Activity and Quality of Life in Children and Youth with Diabetes in the BC Interior

Ty Sideroff, Nick Wall, Alex Myshak-Davis, Kiera Lee-Pii, Simran Gill, Holly Buhler, Deanne Taylor, Trent Smith, Christine Voss

Background: Inadequate physical activity (PA) is common for all populations, including those with diabetes. Beyond diabetes disease management, PA may have an important role in a child’s quality of life (QoL). This ongoing observational longitudinal study aims to quantitatively assess habitual PA levels via commercial activity trackers (Fitbit Charge 5) and explore associations between PA levels and perceived QoL in children and youth with diabetes in the BC Interior.

Methods: Children and youth (5-19yrs) with diabetes (any type), who had received pediatric diabetes care through Interior Health in the Okanagan region during the previous 12 months, were invited to the study. At baseline, participants completed a validated, age-appropriate Pediatric Quality of Life Inventory (PedsQL) survey via REDCap (8-19yrs only). A higher PedsQL score (0-100) indicates better QoL. To assess PA, participants wore a commercial activity tracker (Fitbit Charge 5) consecutively for 28 days. These assessments were repeated six months following baseline if consent was given. Intra-day Fitbit data were extracted to REDCap via a custom-written application programming interface (API), and median steps/d were calculated for valid days (>600 min wear time). Analyses were completed in R, and significance was set at p<0.05.

Results: 58 participants (12.8+3.9yrs, 41% girls) have completed baseline data collection. Thus far, 10 participants (13.3+4.9yrs, 50% girls) have also completed data collection for the 6-month follow-up. At baseline, their median total PedsQL score was 77.0 (IQR: 74.8-78.6), and the median steps/day was 9493 (IQR: 7771-11654). There was a significant correlation between total PedsQL score and steps/day (rho=0.29; p=0.04). There was no significant difference in age, steps/day or PedsQL score between those who have and haven’t completed the follow-up assessments. At six months follow-up, neither QoL nor daily PA significantly changed from baseline (p=0.93 and 0.38 respectively): Median PedsQL was 73.75 (IQR: 71.72-75.47) and median steps/day was 10002 (IQR: 9075-12519).

Conclusion: This preliminary analysis suggests that there may be an association between QoL and PA levels in children and youth with diabetes in the BC Interior. Future follow-up and qualitative assessments will shed light on potential causal associations and will help to improve clinical recommendations and adherence.