Multiple Chronic Conditions Before Pregnancy and Risk of Adverse Maternal Health Outcomes: Population-Based Cohort Study.

Objective: To assess the risks of perinatal emergency department (ED) use, hospitalisation and severe maternal morbidity or mortality (SMM-M) associated with preconception MCC, according to the number of chronic conditions, complex MCC and co-occurring cardiometabolic conditions.

Design: Population-based cohort study.

Setting: Ontario, Canada.

Building Bridges: Developing and Implementing a New Transition to Adult Care Program for Youth with Complex Healthcare Needs at a Canadian Children's Hospital.

: Transitioning from pediatric to adult services can be challenging for youth with complex chronic health conditions, especially those with multi-morbidity. These youth often require extra coordination and support during this phase of their healthcare journey. Building upon existing provincial and national initiatives for transitions from pediatric to adult healthcare services, we have developed a hospital-wide program within one of Canada's largest children's hospitals that incorporates an integrated care model aimed at better serving these patients and improving outcomes.

Low-Value Computed Tomography for Children in the Emergency Department: A Repeated Cross-Sectional Study.

Objectives: To compare low-value computed tomography (CT) use during pediatric emergency department (ED) visits by hospital type and physician specialty.

Methods: Repeated cross-sectional study using linked databases from Ontario, Canada. We reviewed pediatric ED discharges from 2010 to 2019 for 5 diagnoses with recommendations against routine CT use: abdominal pain, constipation, concussion, seizure, and headache.

A Comparison of LASIK Outcomes for High Versus Low Myopia: Large Data Analysis.

Purpose: To compare the visual and refractive outcomes of low versus high myopic correction using laser in situ keratomileusis (LASIK) surgery.

Methods: Patients who underwent myopic LASIK between January 2013 and December 2023 were included. Eyes were divided into two groups based on preoperative myopia severity: low (0.

Competency-based training for paediatric residents caring for children with medical complexity.

Children with medical complexity (CMC) are characterized by medical fragility, multisystem disease involvement, and medical technology use. Due to the complexities of care needs, CMC requires a tailored approach to care relying on intensive care coordination and consideration of the family and caregiver experience. With increasing access to medical technology and technological innovation that has improved, the prevalence of CMC is increasing.

Adverse Physical Health Outcomes and Healthcare Service Utilization in Siblings of Children With Cancer: A Systematic Review.

Introduction: Siblings of children with cancer may be vulnerable to compromised long-term health. We aimed to describe the frequency (prevalence, incidence) of adverse physical health outcomes and healthcare service utilization among siblings of children with cancer and compare the risk of the above outcomes to siblings of children without cancer.

Methods: We searched Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Clarivate Web of Science through June 15, 2024.

Using experience-based co-design to explore care experiences and identify practice change priorities for children with medical complexity in the paediatric intensive care unit.

Objectives: Children with medical complexity (CMC) frequently experience acute deterioration requiring paediatric intensive care unit (PICU) hospitalisation. Collaboration between families and healthcare professionals (HCPs) is vital yet often challenging, suggesting a new care approach is needed. This study explored the PICU care experiences of CMC, parents and HCPs and identified common priorities and practice changes to enhance care.

Maternal Disability and Emergency Department Use for Infants.

Importance: Infants have among the highest rates of emergency department (ED) visits of all age groups. Women with disabilities experience significant social disparities, may experience barriers accessing child primary care, and may seek care in the ED.

Objective: To compare ED use among newborns and infants (hereafter infants) of women with or without disabilities, overall and by timing and acuity of the ED visit.

Co-creation and evaluation of online care maps for children with medical complexity.

Background: Care maps are a caregiver-created diagrammatic tool to support the care of children with medical complexity (CMC). They provide a high-level overview of care, allowing the care team to appreciate the interrelatedness of medical and non-medical aspects of care. Limitations currently exist for the usability, shareability, and integration of care maps into clinical care as they are typically paper-based and caregiver-held.

Impact of Pupil-Decentration on Visual and Refractive Outcomes in Myopic Patients Undergoing High Astigmatic PRK Surgery.

: To compare the visual and refractive outcomes of myopic patients undergoing high astigmatic photorefractive keratectomy (PRK) surgery with and without pupillary decentration of treatment. : In this retrospective study, we reviewed the medical records of myopic patients who underwent PRK surgery for high astigmatism (>3 diopters [D]) between January 2013 and December 2023. The patients were divided into two groups based on whether the surgeon applied pupillary decentration during surgery.

Inequalities in paediatric hospitalisations for costly and prevalent conditions in Ontario, Canada: a population-based cohort study.

Background: Identifying inequalities is important for informing research, and policy efforts to reduce health disparities. This study measured the inequalities in hospitalisations for the costly and prevalent conditions in hospitalised children using association estimates.

Methods: Population-based cohort study using health administrative databases in Ontario, Canada between 2014 and 2019.

Descemet Stripping Only for Symptomatic Fuchs Endothelial Dystrophy-A Retrospective Case Series Comparing ROCK-I vs. Hypertonic Sodium Chloride for Post-Surgical Adjuvant Therapy.

: To report our experience with Descemet stripping only (DSO) for the treatment of Fuchs endothelial corneal dystrophy. Thirteen eyes of 9 patients with symptomatic Fuchs endothelial dystrophy underwent a 4 mm central Descemetorhexis without graft implantation between June 2017 and July 2020. All patients had central confluent guttata, undetectable central endothelial cell count by specular microscopy, and healthy peripheral corneal endothelium.

A population-based cohort study of perinatal mental illness following traumatic brain injury.

Aims: To examine the risk of perinatal mental illness, including new diagnoses and recurrent use of mental healthcare, comparing women with and without traumatic brain injury (TBI), and to identify injury-related factors associated with these outcomes among women with TBI.

Methods: We conducted a population-based cohort study in Ontario, Canada, of all obstetrical deliveries to women in 2012-2021, excluding those with mental healthcare use in the year before conception. The cohort was stratified into women with no remote mental illness history (to identify new mental illness diagnoses between conception and 365 days postpartum) and those with a remote mental illness history (to identify recurrent illnesses).

Research quality and dissemination of paediatric randomised controlled trials with and without patient and family engagement: systematic review.

Objectives: Authentic patient and family engagement in child health research is defined as researchers working in partnership with patients and families on all aspects of the research process, including refining the research question, tailoring the intervention, devising study procedures and disseminating study findings. While there is good evidence of a positive impact of patient engagement on the research process, on research teams and on patient partners, there are few empirical data on the impact of patient and family engagement on research quality and dissemination. We conducted a systematic review to compare research quality and dissemination metrics for paediatric randomised controlled trials (RCTs) that engaged patients and families in the research process with trials that did not.

Enhancing the experience and outcomes of children with complex care needs in acute paediatric settings: a realist review protocol.

Introduction: The number of babies, children and young people with complex care needs (henceforth children with complex care needs (CCCN)) in England has increased in recent decades, and this has also been recognised globally. CCCN may have frequent and lengthy hospital admissions, but during these episodes, their needs are not always met, potentially resulting in suboptimal experiences and outcomes. Despite increased numbers of CCCN accessing acute care and displaying greater complexity, much of the contemporary literature has focused on primary care coordination between health, education and social care.

Exploring the impact of pupil expansion techniques on cataract surgery: unveiling key complications and clinical outcomes: a comparative analysis of 1266 eyes.

Background: In cataract surgery, inadequate pupil dilation presents a major surgical challenge by narrowing the operation field and restricting visibility and movement. We aim to compare cataract surgery complication rates and clinical outcomes using different pupil expansion methods.

Methods: This retrospective cohort study grouped patients according to four techniques of mechanical pupil expansion techniques: sphincterotomy (N = 339), iris stretching (N = 242), iris hooks (N = 391) and expansion rings (N = 294).

Maternal-newborn ABO Blood Group Congruence Among Consecutive Births and Risk of Serious Neonatal Infection: Retrospective Cohort Study.

Background: Differing ABO blood groups between a mother and her fetus may confer a lower risk of serious neonatal infection. How sensitization in the first pregnancy influences this phenomenon in a subsequent pregnancy is unclear. Accordingly, this study determined whether maternal-newborn ABO blood group incongruence in a first pregnancy further modifies the risk of serious infection in a subsequent pregnancy marked by ABO incongruency.

Indications and outcomes of pediatric high flow nasal cannula use in the home setting.

Objective: To describe the patient characteristics, indications, and clinical outcomes of home high flow nasal cannula (HFNC) among pediatric patients. To evaluate secular trends in home HFNC initiation between 2013 and 2022.

Methods: A retrospective review of all children on home HFNC between 2013 and 2023 was conducted at a tertiary care pediatric hospital in Ontario, Canada.