Health Care Utilization and Costs in Ventilator-Dependent Children and Adults Receiving an eHealth Intervention During the COVID-19 Pandemic.

During the COVID-19 pandemic, we implemented the Long-term In-Home Ventilator Engagement (LIVE) intervention to provide virtual specialist care. Using a matched home mechanical ventilation control group, we compared publicly funded health-service utilization and costs for ventilator-dependent children and adults receiving the LIVE eHealth intervention. LIVE users were matched to controls on age, sex, ventilation type, years on ventilation, and reason for ventilation.

Disease-modifying therapies for spinal muscular atrophy: Family experience, ethical considerations, and the role of social determinants of health.

Objectives: Spinal muscular atrophy is a progressive neuromuscular condition associated with a complex chronic disease course. An in-depth understanding of the ethical issues and social determinants of health impacting the experiences of families and children living with this condition is critical to improving care delivery. We identified the ethical tensions faced by families caring for children with spinal muscular atrophy as well as the influence of social determinants of health in relation to their perception of novel disease-modifying therapies.

The prevalence of vagus nerve stimulator-induced sleep disordered breathing in children with refractory Epilepsy: A retrospective cohort study.

Rationale: Vagus nerve stimulators (VNS) can reduce seizure burden in children but may result in sleep-disordered breathing (SDB). Our objectives were to assess the prevalence of SDB in children with epilepsy using polysomnography (PSG) before and after VNS implantation as well to explore management strategies for VNS-induced SDB.

Methods: A retrospective cohort study was conducted (May 2019 to September 2024) of children aged 0-18 years old with refractory epilepsy and VNS insertion at The Hospital for Sick Children, Toronto, Canada.

The association between insomnia, chronotype, and positive airway pressure adherence in children and adolescents.

Study Objectives: Positive airway pressure (PAP) therapy is highly efficacious for the treatment of sleep-disordered breathing in children but is limited by poor adherence. We sought to evaluate the relationship between insomnia and chronotype on PAP adherence in children.

Methods: This is a cross-sectional study conducted at the Hospital for Sick Children (Toronto, Canada) of children aged 4-18 years old prescribed PAP for a minimum of six months.

Family Caregivers of Individuals With Neuromuscular Disease Participating in a Randomized Controlled Trial of a Digital Peer Support Program: Nested Qualitative Study.

Background: Family caregivers have primary responsibility for providing care in the home for people with neuromuscular diseases (NMDs). This may negatively affect caregiver health. Peer support may enhance quality of life and reduce stress among family caregivers, but few trials have been conducted in NMD caregivers.

Successfully escaping the pleura with the extra-vascular implantable cardioverter defibrillator lead: a case report.

Background: Extra-vascular implantable cardioverter defibrillator (EV-ICD) is an emerging technique for ICD implantation with substernal lead placement. The system avoids the vasculature and can deliver anti-tachycardia and pause prevention pacing, with a generator size smaller than the existing subcutaneous device. While this device is now widely available, little is known about potential complications that may follow its implantation in real life context.

Outcomes and measures in studies of techniques to promote secretion clearance in individuals with neuromuscular conditions: a scoping review.

Background: Techniques to support secretion clearance for individuals with neuromuscular conditions and respiratory muscle weakness include mechanical insufflation-exsufflation and chest wall vibrations. Assessing the comparative efficacy of these techniques is challenging due to the absence of a core outcome set. We sought to describe outcomes and measurement instruments reported in studies of airway clearance techniques for individuals with neuromuscular conditions living in the community.

Evaluation of Laser-Assisted Bone-Cutting Techniques Compared to Traditional Methods.

Background: Laser-assisted bone cutting has emerged as a promising alternative to traditional methods, such as rotary instruments and saws. The technique is considered minimally invasive, offering potential benefits in precision, reduced trauma, and faster healing.

Materials And Methods: A randomized clinical trial was conducted involving 100 patients requiring bone resection for various dental procedures.

Extreme pediatric obstructive sleep Apnea: Clinical Features, management, long-term outcomes and mortality.

Objectives: Extreme obstructive sleep apnea (OSA), defined by an obstructive apnea-hypopnea index (OAHI) ≥100 events/hr, presents management challenges in pediatric patients due to its severity and associated comorbidities. This study aims to review the clinical characteristics, management strategies, and outcomes in this population.

Methods: Retrospective reviewed patients aged ≤18 years with extreme OSA who underwent level 1 polysomnography (PSG) from 2010 to 2024.

The VARIPULSE Pulsed Field Ablation Platform.

The VARIPULSE platform including a variable loop catheter, TRUPULSE Generator, and CARTO 3 Mapping System VARIPULSE Service Pack Software, has been developed to deliver pulsed field ablation (PFA) in combination with the benefits of electroanatomical mapping. In preclinical studies, delivery of PFA using the VARIPULSE platform has been found to be safe and feasible with evidence of durable ablation lesions within the atria. Clinical studies have demonstrated the system to be safe and feasible to facilitate pulmonary vein isolation for paroxysmal atrial fibrillation ablation, without esophageal or phrenic nerve injury and low rates of arrhythmia recurrence at 12 months.

Radiofrequency-aided venous ethanol vs optimized radiofrequency for primary and repeat ablation of left ventricular summit arrhythmias: A propensity score-matched comparison.

Background: Radiofrequency (RF) ablation of left ventricular summit arrhythmias (LVSAs) is challenging and may fail due to the anatomical inaccessibility of the substrate. Coronary venous ethanol ablation (CVEA) has been suggested as an alternative ablation strategy for drug- and RF-refractory LVSA.

Objective: This study compared venous ethanol with or without adjunctive RF (CVEA ± RF) vs optimized RF (ORF) for primary or repeat ablation of LVSA.

Prevalence of Altered Craniofacial Morphology in Children With OSA.

Snoring and obstructive sleep apnoea (OSA) affect a significant percentage of children. Recent studies have suggested that altered craniofacial morphology may contribute to the multifactorial pathophysiology of OSA. This study aims to determine the prevalence of craniofacial abnormalities and malocclusion in children referred for polysomnography due to OSA suspicion.

Core Outcome Set for Studies Investigating Secretion Clearance Interventions Used in the Community by Patients With Neuromuscular Disease.

Several treatments are used in the community to improve secretion clearance for patients with neuromuscular disease (NMD). However, the optimal intervention remains unclear with further research required. We aimed to develop a core outcome set (COS) for studies investigating secretion clearance interventions used in the community by patients with NMD.

Positional therapy for the treatment of positional obstructive sleep apnea in children: A randomized controlled crossover trial.

Background: Obstructive sleep apnea (OSA) is prevalent in children, but many children remain untreated. Up to one half of children with OSA have positional OSA, a phenotype characterized by the predominance of airway obstruction while supine. Positional devices that prevent sleeping supine may be beneficial for positional OSA.

IMPAIRED ORAL HEALTH-RELATED QUALITY OF LIFE IN INDIVIDUALS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A SYSTEMATIC REVIEW.

Background: Chronic obstructive pulmonary disease (COPD) has been associated with various health implications, including potential effects on oral health and Oral Health-Related Quality of Life (OHRQoL). Understanding the relationship between COPD and dental health is crucial for optimizing patient care and well-being. This review aims to assess the existing literature on the impact of COPD on oral health and OHRQoL.

Evaluation of the Effect of Functional Contouring of the Palatal Vault of Maxillary Complete Denture on Clarity of Speech Sounds in Edentulous Patients: An Study.

Background: The articulatory system, which consists of the tongue, lips, teeth, hard palate, and soft palate, is a component of phonetics, the study of speech sounds. Speech sounds are negatively impacted by the lack of teeth and surrounding tissues in edentulous people. Phonetics has not gotten the same level of attention as denture mechanics and aesthetics, despite notable developments in these areas.

Evaluation of the Efficiency of Ultrasonography and Color Doppler in Diagnosis of Intraosseous Jaw Lesions: An Study.

Aim: The current investigation aimed to evaluate the accuracy of ultrasonography and color Doppler performed in the diagnosis of intraosseous jaw lesions.

Materials And Methods: A total of 30 patients with intraosseous jaw lesions between the ages of 12 and 60 were selected for the present study. For every jaw lesion, a preliminary diagnosis was done using preoperative conventional radiographs.

Factors associated with lower forced vital capacity in children and adults with Duchenne muscular dystrophy using non-invasive ventilation: a multicenter analysis.

Background: Reduced forced vital capacity (FVC) is associated with morbidity and mortality in individuals with Duchenne muscular dystrophy (DMD). Non-invasive ventilation (NIV) is often prescribed for the treatment of sleep-disordered breathing (SDB), and chronic respiratory insufficiency. Despite the common practice of initiating NIV later in the progression of DMD, the factors influencing FVC subsequent to the commencement of NIV remain unclear.

Complications that arise with nasogastric tubes after hospitalization in the pediatric population: A mixed methods systematic review.

Children use nasogastric tubes (NGTs) to ensure optimum nutrition and medication delivery when oral feeding fails or when they experience faltering growth. Although this method is less invasive, children may experience complications associated with NGTs. There is a gap in the literature regarding the types and prevention of complications of NGTs in the pediatric population at home.

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.

Amelioration: An Innovative Approach to Behavior Management Based on Cognitive Process.

Aim: The study aimed to determine the applicability of psychological traits identified by Piaget sixty years ago to children in the current generation and to utilize these traits clinically for behavior modification.

Methods: A cross-sectional study was conducted with 200 participants aged 4-7, divided into four groups. Three tests were administered to evaluate the manifestation of preoperational features.

An algorithm for discontinuing mechanical ventilation in boys with x-linked myotubular myopathy after positive response to gene therapy: the ASPIRO experience.

X-linked myotubular myopathy (XLMTM) is a rare, life-threatening congenital myopathy. Most (80%) children with XLMTM have profound muscle weakness and hypotonia at birth resulting in severe respiratory insufficiency, the inability to sit up, stand or walk, and early mortality. At birth, 85-90% of children with XLMTM require mechanical ventilation, with more than half requiring invasive ventilator support.