Attendees are encouraged to ask questions! To ask a question use the Chat feature or unmute your mic during the designated Q&A period Need technical support or closed caption turned on? Type ‘HELP’ into the Chat This session is being recorded and will be distributed online For questions or concerns contact reseduc@bcchr.ca
Session #1: Clinical Beenu (Barinder) Bajwa Laeticia Brice Parnian Hosseini Martina Knappett
Michelle Lisonek Samantha Pawer Olivia Scoten Natalie South
Judge: Sarah Hutchison
Beenu (Barinder) Bajwa
#1
Medical Student, University of British Columbia Supervisor: Jugpal Arneja, Evidence to Innovation The Environmental Impact of Ambulatory Surgical Centres Survey
Abstract & Poster - https://bcchr.ca/posterday
Beenu Bajwa
1 BSC ;
Dr. Zach Zhang
1,2 MD ,
Young Ji Tuen
2 BA ,
Jugpal Arneja
1,2 MD
1 Faculty of Medicine, University of British Columbia, Vancouver ,BC, Canada; 2 Division of Pediatric Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada,
Preliminary Findings
Background • Global warming has emerged as a social, political, and financial crisis and health facilities are not immune as contributors to climate change1. • The operating room (OR) is a significant resource consuming section of the health care facilitates and presents an 2 opportunity to analyze and manage its carbon footprint . • Institutional barriers to implementing evidence-based green practices may be lower in non-hospital surgical centers where medical directors have greater capacity to enact measures such as using LED lights and environmentally friendly anesthetic gases as well as reusing surgical gowns and drapes 2,3,4.
Study Objectives 1. To review current practices and attitudes towards going green for surgery procedures. 2. To determine barriers that may exist when implementing environmental sustainability efforts. 3. To review and compile strategies and educational initiatives to increase sustainable practice.
Methods • All non-hospital medical surgical facilities in British Columbia were sent a letter of invitation and survey by mail. • The survey asked questions regarding waste management, anesthetic gases, energy use in the OR and multidisciplinary OR staff education.
Awareness
Initiatives
The surgical centers agree that the environmental impact of surgery is an essential factor to be considered and are willing to change their practice to reduce their carbon footprint. They do not have a written plan to reduce their carbon footprint, a net zero target, sustainability lead or have received training/education on environmental sustainability
Significance • We hope that the findings of our study can provide a provincewide snapshot of current practices and efforts towards environmental sustainability in non-hospital surgical centers. • Our results may help inform future environmental sustainability programs and cost-effective best practices.
References 1: Holmner, Å., Rocklöv, J., Ng, N. and Nilsson, M., 2012. Climate change and eHealth: a promising strategy for health sector mitigation and adaptation. Global Health Action, 5(1), p.18428. 2: Wu, S. and Cerceo, E., 2021. Sustainability Initiatives in the Operating Room. The Joint Commission Journal on Quality and Patient Safety, 47(10), pp.663-672. 3: Gadani, H. and Vyas, A., 2011. Anesthetic gases and global warming: Potentials, prevention and future of anesthesia. Anesthesia: Essays and Researches, 5(1), p.5. 4: Vozzola, E., Overcash, M. and Griffing, E., 2020. An Environmental Analysis of Reusable and Disposable Surgical Gowns. AORN Journal, 111(3), pp.315-325.
Laeticia Brice
#2
Master’s Student, University Pierre et Marie Curie/University of British Columbia Supervisor: Todd Woodward, Brain, Behaviour & Development Creating an Anatomical and functional Atlas of task-based networks detectable by fMRI: Analyzing a ball squeezing task Abstract & Poster - https://bcchr.ca/posterday
Creating an Anatomical and functional Atlas of task-based networks detectable by fMRI: Analyzing a ball squeezing task. Laeticia Brice, Justin Andrushko, Linda Chen, Chantal Percival, Todd Woodward 1BC
Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada, 2Faculty of Science, University of British Columbia, Vancouver, BC, Canada, 3Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, 4Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada, 5Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Introduction •
Results
The Woodward Lab as created, over the year, an atlas of task-based networks detectable by Functional Magnetic Resonance Imaging (fMRI), by analyzing there previous work. Left_Imagine
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Now it’s necessary to prove the reliability of this atlas by replicating this methods to other study, from other lab. Here the analysis was based on the study of M.Crotti et al. (1) from Graz University in Austria. In this study all participants were healthy. They had to, in a first run, imagine squeezing a ball that they had on there hands, with the Right hand, Left hand or Both hand, based on instruction displayed on a screen. Then, during the second run, they had to actually execute this movement.
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• It’s more deactivated when both hand were used. The greater the deactivation, the harder the task.
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1. The raw Data was download from Github. 2. The preprocessing was done with FSL and SPM12. 3. A Functional Magnetic Resonance Imaging Constrained Principal Component Analysis (fMRI-CPCA) (2) was used to analyze the data. The Hemodynamic Response (HDR) shape was created with the extraction of all Bold-OxygenResponse (BOLD) variation during the task. 4. These responses was then compared to the atlas to find similar networks. 5. The brain image was done on MRIcron.
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• When one hand is used, only the opposite hemisphere is activated.
Networks from the Woodward Lab Atlas have been observed. When the task was to be executed the Response network peaked in activity, and was higher when both hand were used. The Focus On Visual Features Network was deactivated when only one hand was required, particularly when the participant had to imagine the movement. This reflects the requirement to ignore part of the screen display to concentrate on which hand to use. When a motor movement is executed, the left-right contrast network is invoked when only one hand is used. This is not a typical network but reflects the nature of this particular task. All networks that was used during this squeezing ball task can be seen by fMRI.
References 1) M.Crotti, K.Koschutnig, S.C.Wriessnegger (2022) Handedness impacts the neural correlates of kinesthetic motor imagery and execution: a FMRI study (Journal of Neuroscience Research). 2) M.A.Hunter, Y.Takane (2002) Constrained Principal Component Analysis: Various Applications (Journal of Educational and Behavioral Statistics)
Parnian Hosseini
#3
Medical Student, University of British Columbia Supervisor: Nassr Nama, Evidence to Innovation Describing Canadian infants with BRUE and validating a BRUE risk stratification tool
Abstract & Poster - https://bcchr.ca/posterday
DESCRIBING CANADIAN INFANTS WITH BRUE AND VALIDATING A BRUE RISK STRATIFICATION TOOL Parnian Hosseini, Zerlyn Lee, Falla Jin, Nassr Nama
Background
However, in the following years studies demonstrated
Brief resolved unexplained events (BRUEs) are common amongst infants and a cause of concern for parents. In 2016, the American Association of Pediatrics (AAP) defined: • BRUEs, • criteria for events at low/high risk of recurrence or serious underlying diagnosis, • guideline for management of low risk events1.
BRUE Definition A brief and resolved event Involving one or more of :
87-92% of patients meet high risk criteria2,3. ~4% of patients
2,3 had a serious underlying diagnosis .
0.6-0.9% of laboratory and 1.6-1.9% of ancillary tests were diagnostic2,4. AAP guidelines has a 98% negative predictive and 5% positive predictive value for identifying a serious 5 underlying diagnosis . Recently, a new clinical prediction tool for high-risk events has been developed, demonstrating a better discrimination compared to the AAP guidelines (area under the curve of 0.68 vs. 0.54)4.
•Cyanosis or pallor •Apnea or irregular breathing •Change in tone •Altered level of consciousness
Additionally, there have been no studies in Canada No explanation after a detailed history and physical exam describing the demographics and management of Management of low-risk events infants presenting with BRUE. Low risk criteria 1. age >60 days; 2.gestational age ≥ 32 weeks, corrected to ≥ 45 weeks; 3. event <1 minute; 4.a history of only one event, 5.no cardiopulmonary resuscitation (CPR) administered 6.no concerning features on history or 7. physical exam
Guidelines recommended • against laboratory investigations, consultation, or hospital admissions for monitoring. • focus on patient and familycentered care and use of a shared-decision making model to inform care
Study Goals Describe the population of BRUEs in Canada Describe the clinical practices related to BRUE in Canada Compare the population and clinical practices across Canada Validate the new clinical prediction tool
Methods Retrospective cohort study involving 11 sites across Canada. Eligibility: • Infants (<1 year) • present with a BRUE • between January 1, 2017, and December 31, 2021, Eligible patients will be identified using diagnostic codes. Outcomes: • Primary: presence of a serious underlying diagnosis • Secondary: • BRUE recurrence • hospital length of stay • variation in demographics and treatment across Canada.
Expected Results When applied retrospectively in Canada, the clinical prediction tool will identify infants with a serious underlying diagnosis and recurrent event with higher sensitivity and specificity than the AAP guidelines.
Acknowledgements This project was funded by the BCCHR Summer Studentship program
References 1. Tieder JS, Bonkowsky JL, Etzel RA, et al. Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants. Pediatrics 2016;137:e20160590. 2. DeLaroche AM, Haddad R, Farooqi A, et al. Outcome Prediction of Higher-Risk Brief Resolved Unexplained Events. Hosp Pediatrics 2020;10:2019–0195. 3. Tieder JS, Sullivan E, Stephans A, et al. Risk Factors and Outcomes After a Brief Resolved Unexplained Event: A Multicenter Study. Pediatrics 2021;148:e2020036095. 4. Stephans A, Westphal K, Sullivan E, et al. "Utility of Diagnostic Testing in Patients who Present with Brief Resolved Unexplained Event" (2021). Presentations. 30. 5. Nama N, Hall M, Neuman M, et al. Risk Prediction for Underlying Diagnosis and Recurrence of Brief Resolved Unexplained Events. Pediatrics (under review) 2022. Bochner R, Tieder JS, Sullivan E, et al. Explanatory Diagnoses Following Hospitalization for a Brief Resolved Unexplained Event. Pediatrics 2021;:e2021052673.
Martina Knappett
#4
Master's Student, University of Victoria Supervisor: Matthew Wiens, Healthy Starts Pediatric Discharges in Uganda: Health Worker and Caregiver Perspectives
Abstract & Poster - https://bcchr.ca/posterday
Pediatric Discharges in Uganda: Health Worker and Caregiver Perspectives Martina Knappett, Clare Komugisha, Jessica Trawin, Savio Mwaka, Ezrah Bamwesigye, Collins Agaba, Jesca Nsungwa-Sabiiti, Peter Waiswa, J. Mark Ansermino, Niranjan Kissoon, Nathan Kenya Mugisha, Matthew O. Wiens
• Limited evidence on specific barriers to improving standards of discharge care • Objective: To assess health worker and caregiver perceptions of the pediatric discharge process in a nationally representative sample of health facilities in Uganda METHODS • 180 health workers and 180 caregivers were enrolled across 36 health facilities in Uganda
RESULTS – CAREGIVERS
Health workers and caregivers have differing perceptions of deficiencies concerning the adequacy of preparation for discharge.
Health Facility Processes 100% Proportion of Caregivers
INTRODUCTION • Under-five post-discharge mortality rates often exceed in-hospital mortality rates for children living in LMICs, including Uganda1
With facility’s discharge process With number of staff available at discharge
57% 33% 0%
25% 50% Proportion of Health Workers
Figure 1. Health worker satisfaction items, N=180.
75%
40%
Allowed to ask Informed of questions child’s about vulnerability discharge post-discharge
Caregiver Satisfaction (N=180)
45% of health workers were satisfied with their facility’s discharge planning process
Throughout Admission
31%
37%
45%
Figure 3. Caregiver discharge experience items, N=180.
64% of caregivers stated they received at least some postdischarge education
81% of health workers had never scheduled a lower-level follow-up referral
(N=180)
Health Centres (n=65) Hospitals (n=115) 34%
49%
25%
of child's illness
Of health workers were aware of standardized discharge guidelines at their facility
Health Worker Satisfaction
43%
reoccurrence
Health Facility Processes (N=180)
69%
50%
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RESULTS – HEALTH WORKERS
Of health workers typically spend <20 minutes providing discharge education
78%
0%
• Participants underwent structured interviews based on the Pediatric Sepsis CoLab Environmental Scan to elicit their satisfaction and experiences with the discharge process
20%
75%
Health Centres (n=65) Hospitals (n=115)
At Discharge
• Lack of post-discharge vulnerability risk assessment
• Lack of standardized discharge protocol
• Early discharge requests due to high medical bills
• Discharge delays
ç
• Stock-out of essential medications
Figure 2. Common barriers to providing effective discharge care reported by health workers, N=180.
Post-Discharge • Insufficient time to provide postdischarge counselling • Poor mechanisms for community follow-up
74%
Of caregivers felt staff understood their concerns about discharge
82%
Of caregivers considered the timing of discharge convenient
IMPLICATIONS • Findings elucidate key priority areas for future discharge care policies. • Implementation of, and training for, standardized discharge protocols may improve both practices and satisfaction with peri-discharge care in Uganda. REFERENCES 1. Nemetchek B, English L, Kissoon N, et al. Paediatric postdischarge mortality in developing countries: a systematic review. BMJ Open. 2018;8(12).
Michelle Lisonek
#5
Medical Student, University of British Columbia Supervisors: Astrid Christoffersen-Deb & Marianne Vidler, Healthy Starts Manual Removal of Placenta and Retained Products of Conception in the PRECISE Network in Kenya, The Gambia, and Mozambique: Preliminary Results from Literature Review Abstract & Poster - https://bcchr.ca/posterday
Manual Removal of Placenta and Retained Products of Conception in the PRECISE Network in Kenya, The Gambia, and Mozambique: Preliminary Results from Literature Review ,
1 Lisonek,
1 Vidler,
1 Pickerill,
2 Magee,
3 Dadelszen,
1 Bone,
4 Craik,
Michelle Marianne Kelly Laura Peter von Jeffrey Rachel 5 6 7 8 9 9 10 Hawanatu Jah, Hannah Blencowe, Veronique Filippi, Angela Koech, Esperanca Sevene, Salesio Macuacua, Anne Rerimoi 1Department
of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; 2Institute of Women and Children's Health, King's College London, London, United Kingdom; 3Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; 4Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; 5Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia; 6Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA; 7London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK; 8KEMRI-Wellcome Trust Programme, Kilifi, Kenya; 9Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; 10Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom.
BACKGROUND
METHODS
CONCLUSION
• Labour is a complex physiological process involving four stages: (1) onset of labour to full dilation, (2) full dilation to delivery of the fetus, (3) delivery of fetus to expulsion of the placenta, and (4) one hour of observation after expulsion of placenta.1
• Search terms were developed in consultation with a UBC Faculty of Medicine librarian and experts in the field of obstetrics and local clinicians.
• Overall, we found that the practice of routine “vaginal sweep” or “manual removal of products” was not well documented in the literature, both in lowincome settings as well as in developed countries. It is possible that this is due to poor reporting of obstetrics practices, as Darwinkel et al. (2018)11 found that in Kenya, although 94% of clinical officers of reproductive health helped manage manual removal of the placenta, this procedure was rarely mentioned in their hospital records. Recommended clinical practice guidelines stemming from evidence-based findings will have to take into consideration spiritual and cultural beliefs surrounding blood-loss and delivery in these settings.
• The third stage typically lasts 15 minutes, but can be shortened to five minutes with active management of the third stage of labour (AMTSL).1 AMTSL is a package of interventions to decrease the incidence of postpartum hemorrhage (PPH).2,3 • PPH affects about 2% of all people who give birth globally. PPH is associated with a quarter of maternal deaths globally, the number one cause of maternal mortality in low-income settings, and a driver of maternal mortality.2 • Retained placenta is generally defined as placenta that does not spontaneously expel 18 to 60 minutes after delivery of the fetus and can be caused by a variety of obstetric complications, such as placenta accreta or early cervix closure.4 Incidence varies from 0.1% to 3% and, if AMTSL has been unsuccessful, is managed by manual removal of the placenta with analgesia and possibly prophylactic antibiotics. • The PRECISE Network is a multi-institutional collaborative that follows a cohort of 8602 pregnant people and their infants in Kenya, The Gambia, and Mozambique. Data collected from this project will improve understanding of placental disorders. • Initial data from the PRECISE pregnancy cohort demonstrate a high number of healthcare workers reporting “manual removal of the placenta and retained products of conception” after delivery (15-30%). Preliminary inquiries with healthcare workers and local research staff revealed a regular practice of “vaginal sweeps” after labour to assess for blood and/or blood clots. Vaginal evacuation is not routinely recommended due to health risks and patient discomfort.
OBJECTIVES 1. To explore if routine practice of vaginal sweep, vaginal evacuation, or manual removal of products of conception have been documented in subSaharan Africa and other low-income settings. 2. To assess if there is correlation between manual removal of placenta or retained products of conception and key maternal and neonatal outcomes, as well as differences in perceived and experienced quality of care (future directives)
• PubMed search terms included “vaginal sweep”, “digital sweep”, “manual removal of blood”, “manual removal of placenta”, and “Africa”. The Ovid MEDLINE search was guided by a librarian and included a large, robust, list of search terms. • References of relevant identified papers were searched for additional informative articles. • Publications from all years available were considered, and papers were only assessed if they were written in English. The search was open to primary, secondary, and tertiary sources, as well as the grey literature.
RESULTS • No literature was found describing the phenomenon we have seen in our PRECISE cohort of routine “vaginal sweeps” or “manual removal of products of contraception” during the third stage of labour in sub-Saharan Africa. In Nigeria, 102 (14.5%) females who had given birth in the last two years reported the birth attendant “scooping” out blood within 24 hours of delivery. Furthermore, “scooping” blood during delivery was believed to decrease post-partum bleeding.5 (2020)6
• Koh et al. describe a practice of bimanual clot evacuation (BCE) in Australia, which involves holding the uterus and digitally removing blood clots through the vagina. The authors argue this may be a method of controlled PPH, despite not being recommended by obstetric and gynaecologic colleagues. • Qualitative studies of maternal beliefs of labour help elucidate cultural practices integrated into healthcare in sub-Saharan Africa. Mothers and/or birth attendants from Uganda, Madagascar, and Nigeria all shared sentiments of “bad”, “dirty”, and/or “diseased” blood generally associated with childbirth , including immediately after delivery.5,7,8 Various beliefs are held by patients and health care providers regarding acceptable blood loss levels during labour. As such, practices promoting the expulsion of “diseased” blood, ensuring it does not cause believed complications such as pain, infection, infertility, or death.5,7 • Two Nigerian studies reported high manual removal of placenta rates (11.7% and 13.1%), which may indicate a similar practice of routine vaginal evacuation.9,10
FUTURE DIRECTIVES • Next steps include assessing correlation between manual removal and relevant pregnancy and delivery outcomes in the PRECISE cohort. Analyses will consider infection postpartum, key neonatal and maternal outcomes, as well as perceived and experienced quality of care. Ultimately the project may contribute to guiding evidence-based clinical care in pregnancy and postpartum in sub-Saharan Africa. • Future research can continue to build a context around this practice by investigating the qualitative aspect of routine vaginal evacuation.
REFERENCES 1Dutta,
D., 2015. DC Dutta’s Textbook of Obstetrics, 8th ed. Jaypee Brothers Medical Publishers (P) Lts. 2WHO, 2012. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Italy. 3Oladapo, O.T., Fawole, A.O., Loto, O.M., Adegbola, O., Akinola, O.I., Alao, M.O., Adeyemi, A.S., 2009. Active management of third stage of labour: a survey of providers’ knowledge in southwest Nigeria. Arch Gynecol Obstet 280, 945. https://doi.org/10.1007/s00404009-1036-x 4Perlman, N.C., Carusi, D.A., 2019. Retained placenta after vaginal delivery: risk factors and management. Int J Womens Health 11, 527– 534. https://doi.org/10.2147/IJWH.S218933 5Yargawa, J., Fottrell, E., Hill, Z., 2021. Women’s perceptions and self-reports of excessive bleeding during and after delivery: findings from a mixed-methods study in Northern Nigeria. BMJ Open 11, e047711. https://doi.org/10.1136/bmjopen-2020-047711 6Koh, P.R., Di Filippo, D., Bisits, A., Welsh, A.W., 2020. Bimanual examination for clot evacuation: a retrospective cohort study of women with postpartum haemorrhage after vaginal delivery. BMC Pregnancy Childbirth 20, 245. https://doi.org/10.1186/s12884-02002916-w 7Ononge, S., Okello, E.S., Mirembe, F., 2016. Excessive bleeding is a normal cleansing process: a qualitative study of postpartum haemorrhage among rural Uganda women. BMC Pregnancy and Childbirth 16, 211. https://doi.org/10.1186/s12884-016-1014-9 8Morris, J.L., Short, S., Robson, L., Andriatsihosena, M.S., 2014. Maternal health practices, beliefs and traditions in southeast Madagascar. Afr J Reprod Health 18, 101–117. 9Eleje, G.U., Ugwu, E.O., Dinwoke, V.O., Enyinna, P.K., Enebe, J.T., Okafor, I.I., Onah, L.N., Umeononihu, O.S., Obiora, C.C., Nweze, S.O., Emeka, E.A., Anyaoku, C.S., Ezugwu, F.O., 2020. Predictors of puerperal menstruation. PLOS ONE 15, e0235888. https://doi.org/10.1371/journal.pone.0235888 10Adewuya, A., Ologun, Y., Ibigbami, O., 2006. Post-traumatic stress disorder after childbirth in Nigerian women: prevalence and risk factors. BJOG: An International Journal of Obstetrics & Gynaecology 113, 284–288. https://doi.org/10.1111/j.1471-0528.2006.00861.x 11Darwinkel, M.C., Nduru, J.M., Nabie, R.W., Aswani, J.A., 2018. Evaluating the role of clinical officers in providing reproductive health services in Kenya. Human Resources for Health 16. https://doi.org/10.1186/s12960-018-0296-6
ACKNOWLEDGEMENTS We would like to thank all of the clinicians, scientists, and research personnel who helped conceptualize and organize this project. We would especially like to thank all of the women in the PRECISE Network, without whom this research would not be possible.
Samantha Pawer
#6
Medical Student, University of British Columbia Supervisor: Matthias Görges, Evidence to Innovation Identification of features for a peer support mental health app for adolescents with type 1 diabetes
Abstract & Poster - https://bcchr.ca/posterday
Identification of features for a peer support mental health app for adolescents with type 1 diabetes Samantha
1,2 Pawer ,
Titilola
2,3 Yakubu ,
Tricia S.
4 Tang ,
Matthias
2,5 Görges
1Faculty
of Medicine, UBC; 2BC Children’s Hospital Research Institute; 3Experimental Medicine Program, UBC; 4Division of Endocrinology, UBC; 5Department of Anesthesiology Pharmacology & Therapeutics, UBC
Background and Objectives • People with type 1 diabetes (T1D) cannot make insulin to regulate their blood glucose levels • Approximately 35% of adolescents with T1D experience diabetes distress1
• T1D REACHOUT app developed for adults in BC to address diabetes distress
Feeling Isolated 24/7 Burden
• It is estimated that there are about 3000 children and youth with T1D in Canada2
Concerns Managing T1D
Diabetes Distress
ParentChild Conflicts
Frustrated with Devices
• Select a trained peer mentor for 1-on-1 support
• Video huddles
3. Explore how REACHOUT can be adapted for adolescents
• Direct messaging
Preliminary Results •Adolescents and parents have different top priorities regarding T1D
• Recruiting 15-18-year-olds with T1D and their parents • Participants sent an online questionnaire
Adolescents
Parents
Day-to-day management
Impact of T1D on adolescent emotional well-being and mental health
• Six focus groups will be held:
Adolescents
2. Determine preferred virtual support delivery modalities
• 24/7 chat room
Methods
BC Children’s Hospital
1. Identify mental health needs of adolescents with T1D
Interior + Island Health Adolescents
•Both groups ranked day-to-day management and becoming more independent in management as important topics •The most commonly discussed topics among parents: 1. Challenges and concerns about T1D management 2. Family conflicts due to T1D-related issues
Parents
Parents
3. A lack of support for parents
• Focus group questions:
Conclusions and Future Directions
Adolescents
Parents
•Type of emotional support needed? •Importance of peer support in T1D management? •Type of virtual platform preferred? •Thoughts on the adult REACHOUT app
•Biggest T1D worry? •What support do you need? •Biggest T1D conflict with child? •Concerns about a T1D app for adolescents?
•Qualitative analysis using NVivo to code data into themes
• Apply focus group findings to the existing REACHOUT app • Evaluate REACHOUT NexGEN as a peer-led mental health support platform for adolescents with type 1 diabetes
•Two independent coders
References and Acknowledgments 1. Hagger, V., Hendrieckx, C., Cameron, F., Pouwer, F., Skinner, T. C., & Speight, J. (2017). Cut points for identifying clinically significant diabetes distress in adolescents with type 1 diabetes using the PAID-T: Results from diabetes MILES Youth–Australia. Diabetes Care, 40(11), 1462–1468. https://doi.org/10.2337/DC17-0441 2. Fox, D. A., Islam, N., Sutherland, J., Reimer, K., & Amed, S. (2018). Type 1 diabetes incidence and prevalence trends in a cohort of Canadian children and youth. Pediatric Diabetes, 19(3), 501–505. https://doi.org/10.1111/PEDI.12566
Thanks to the Community Child Health Endowment Summer Studentship for funding this project
#7 Olivia Scoten
Medical Student, University of British Columbia Supervisor: Patricia Janssen, Healthy Starts Screening for perinatal anxiety disorders: A randomized controlled trial
Abstract & Poster - https://bcchr.ca/posterday
Screening for perinatal anxiety disorders: A randomized control trial Olivia Scoten1, Patricia Janssen2, Cora Keeney3, Nichole Fairbrother3
1BC
Children’s Hospital Research Institute; 2School of Population and Public Health, University of British Columbia; 3Department of Family Practice, University of British Columbia
INTRODUCTION • Anxiety and anxiety related disorders affect 1 in 5 pregnant and postpartum people • These disorders are associated with adverse pregnancy outcomes and prolonged negative effects on the developing infant • Despite high prevalence and profound impact on maternal and infant health, routine screening or these disorders is rarely conducted • Lack of routine screening means that many who could benefit from treatment may not be identified
OBJECTIVE • To evaluate the effectiveness of perinatal anxiety screening with respect to mental health symptoms, treatment seeking, and treatment engagement.
METHODS • Province-wide recruitment via social media • Inclusion criteria: speak English fluently, over the age of 18, pregnant (at least 28 weeks) or postpartum (up to 12 weeks) • At 6-12 weeks postpartum, participants are administered perinatal anxiety screening and randomized to: • (a) screening only • (b) screening + individualized feedback on their anxiety scores • (c) screening + individualized feedback + personalized referrals for treatment options that best suit their needs and preferences • At 6-8 months postpartum, all participants complete a followup questionnaire to assess the impact of condition on outcomes • Primary outcomes: State Trait Anxiety Inventory (STAI), Perinatal Anxiety Screening Scale (PASS), Edinburgh Postnatal Depression Scale (EPDS) • Secondary outcomes: mental health treatment-seeking behaviours, mental health treatment obtained
DATA ANALYSIS PLAN • Baseline characteristics will be summarized by group using mean (SD), median (IQR), and n (%) where appropriate • Differences between groups in STAI, PASS, EPDS, mental health treatment seeking, and mental health treatment obtained at 6-8 months postpartum will be assessed via analysis of variance
HYPOTHESES 1. Compared with participants who are administered screening alone, those who receive screening with feedback, or screening with feedback and referrals will later in the postpartum: • (a) obtain lower scores on measures of anxiety and depression • (b) be more likely to report mental health treatment seeking behaviours; and • (c) be more likely to have accessed treatment for their mental health concerns 2. Participants who are administered screening with feedback and referrals will have better outcomes compared with those receiving screening and feedback only.
CURRENT STATUS • Recruitment and data collection are currently underway • 146 participants have been recruited (desired N=282) and 62 have completed the baseline questionnaire
IMPACT • Findings from this study will yield the first data regarding the effectiveness of perinatal anxiety screening in improving mental health outcomes • This study will provide much needed evidence to support universal screening for perinatal anxiety
ACKNOWLEDGEMENTS • We are thankful for the support received in funding from the Women’s Health Research Institute Catalyst Grant and BC Children’s Hospital Research Institute Healthy Starts Summer Studentship
Natalie South
#8
Medical Student, Royal College of Surgeons Ireland Supervisors: Emily Schaeffer & Kishore Mulpuri, Evidence to Innovation Assessing the Impact of COVID-19 on Health Resource Utilisation by Paediatric Patients with Cerebral Palsy
Abstract & Poster - https://bcchr.ca/posterday
Assessing the Impact of COVID-19 on Health Resource Utilization by Paediatric Patients with Cerebral Palsy Natalie South, Sophia Provenzano, Emily Schaeffer, Stacey Miller, MPT, Maria Juricic, MPT, PhD, Kishore Mulpuri, MBBS, MS(Ortho), MHSc(Epi)
INTRODUCTION Cerebral Palsy(CP) is the most common cause of motor impairment or disability in children.
Management of CP requires medical and surgical attention as well as the support of a variety of healthcare professionals such as: - rehabilitation therapists - occupational therapists - speech language pathologists
METHODOLOGY
OBJECTIVES In this prospective cross-sectional study, we will be assessing the impact of Covid-19 on the health services utilized by paediatric patients with cerebral palsy and comparing them to the results from 2019, prior to the pandemic.
RESEARCH POSTER PRESENTATION TEMPLATE © 2019
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- Adapt the original survey used in 2019 to collect new data on how health care for CP patients has changed throughout the pandemic. - Reach out to all patients involved in the 2019 study by email. - Contact and survey patients with CP who attend the orthopaedic clinic at BC Children’s. - Evaluate the type and frequency of healthcare services used by children with CP over the course of the pandemic.
ANTICIPATED RESULTS It is anticipated that during the pandemic there has been a decrease in the frequency of in-person healthcare visits, specifically rehabilitation services.
IMPLICATIONS The overall goal of the study is to identify gaps in care of patients with CP. It will allow identification of service areas of need, and how resource delivery may need to be adjusted to accommodate patient needs in the event of future pandemics and the evolving balance of virtual and in-person care.
REFERENCES McDowell, BC, Duffy, C, Parkes, J. Service use and familycentered care in young people with severe cerebral palsy: a population-based cross-sectional clinical survey. Disabil Rehabil. 2015. 37(25):2324-2329. Meehan, E, Harvey, A, Reid, SM, Reddihough, DS, Williams, K, Crompton, KE, Omar, S, Scheinberg, A. Therapy service use in children and adolescents with cerebral palsy: an Australian perspective. J of Paediatrics and Child Health. 2016. 52:308-314. “Cerebral Palsy.” CanChild, https://www.canchild.ca/en/diagnoses/cerebral-palsy. “What Is Cerebral Palsy?” Centers for Disease Control and Prevention, 2 May 2022, https://www.cdc.gov/ncbddd/cp/facts.html#:~:text=Depending%20 on%20which%20areas%20of,Poor%20balance%20and%20coordi nation%20(ataxia) Ben-Pazi, H, Beni-Adani, L, Lamdan, R. Accelerating Telemedicine for Cerebral Palsy During the COVID-19 Pandemic and Beyond. Front Neurol. 2020. https://doi.org/10.3389/fneur.2020.00746