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Resuscitation care planning for extremely low gestational age neonates (ELGANs) is complex and ethically charged. Increasing survival at lower gestational ages has had a significant impact on this complexity. It also has an impact on healthcare resource utilization and policy development in Canada. This study sought to determine the current attitudes and practices of neonatologists in Canada, and to assess moral distress associated with resuscitation decisions in the ELGAN population. It also aimed to explore the perspectives of adopting a shared decision-making approach where further data with regard to best interests and prognosis are gathered in an individualized manner after birth. Neonatologists in Canadian level III NICUs were surveyed in 2020. Amongst the 65 responses, 78% expressed moral distress when parents request non-resuscitation at 24 weeks. Uncertainty around long-term outcomes in an era with improved chances of morbidity-free survival was the most prominent factor contributing to moral distress. 70% felt less moral distress deciding goals of care after the baby's initial resuscitation and preferred an individualized approach to palliation decisions based on postnatal course and assessment. While most current guidelines still support the option of non-resuscitation for infants born at less than 25 weeks, we show evidence of moral distress among Canadian neonatologists that suggests the consideration of routine resuscitation from 24 weeks and above is a more ethical approach in the current era of improved outcomes. Canadian neonatologists identified less moral distress when goals of care are developed postnatally, with availability of more evidence for prognostication, instead of antenatally based primarily on gestational age. [ABSTRACT FROM AUTHOR]

En pédiatrie, la prise de décision médicale est compliquée par les variations importantes du développement physique et psychologique observées entre la naissance et l'adolescence. Les parents et les tuteurs sont les décideurs de facto au nom des nourrissons, mais par la suite, leur rôle et celui des patients deviennent de plus en plus complexe. Tout au long de l'enfance, les dispensateurs de soins (DdS), qui ne sont pas des décideurs en soi, ont un rôle important à jouer dans la prise de décision médicale. Le présent document de principes expose les principes éthiques de la prise de décision médicale pour les DdS qui participent aux soins des patients pédiatriques. Cette mise à jour porte sur la prise de décision individuelle dans le cadre de la relation entre le patient et le DdS et fournit plus de conseils en cas de mésententes. [ABSTRACT FROM AUTHOR]

Medical decision-making in the paediatric population is complicated by the wide variation in physical and psychological development that occurs as children progress from infancy to adolescence. Parents and legal guardians are the de facto decision-makers in early infancy, but thereafter, the roles of parents/ legal guardians and paediatric patients become ever more complex. Health care providers (HCPs), while not decision-makers per se, have a significant role in medical decision-making throughout childhood. This statement outlines the ethical principles of medical decision-making for HCPs involved in caring for paediatric patients. This revision focuses on individual decision-making in the context of the patient-provider relationship and provides increased guidance for dealing with disagreements. [ABSTRACT FROM AUTHOR]

On constate des écarts dans les taux de prématurité et de mortalité néonatale au Canada, en partie à cause d'une formation insuffisante en réanimation et en stabilisation néonatales et de même que d'une adhésion inégale aux pratiques exemplaires. Depuis les années 1990, le Programme de réanimation néonatale est la norme dans tous les établissements qui prodiguent des soins périnatals, mais les fournisseurs et les formateurs de soins périnatals ont continué d'observer des lacunes sur le plan des connaissances et des habiletés en matière de stabilisation des nouveau-nés après la réanimation, particulièrement dans les milieux où ces soins sont rarement requis. Le Programme de soins aigus aux nouveau-nés à risque (ACoRN) a été mis sur pied pour corriger ces lacunes. Dans l'ACoRN, une évaluation primaire et des trajectoires pour soigner les divers systèmes organiques (les séquences) priorisent et orientent l'évaluation, les soins essentiels et la prise en charge des nouveau-nés à risque ou malades pendant les premières heures et les premiers jours de vie. Le présent point de pratique fait ressortir les changements aux pratiques et aux recommandations depuis 2012, année de la dernière révision du texte et du fonctionnement de l'ACoRN, qui n'était alors offert qu'en anglais. À l'instar du Programme de réanimation néonatale, l'ACoRN est géré par la Société canadienne de pédiatrie au Canada. Un manuel et un programme d'enseignement révisés, mis à jour, traduits en français et lancés en 2021 standardiseront les soins, accroîtront les compétences et la confiance chez les dispensateurs de soins périnatals et amélioreront les pronostics néonatals au Canada et ailleurs au cours des prochaines années. [ABSTRACT FROM AUTHOR]

Disparities in preterm birth and neonatal mortality rates persist in Canada, in part as the result of insufficient training in newborn resuscitation and stabilization care, and inconsistent adherence to best practices. The Neonatal Resuscitation Program (NRP) has been the standard of care in all facilities providing perinatal care in Canada since the 1990s, but perinatal care providers and educators have continued to recognize gaps in knowledge and skill when stabilizing newborns post-resuscitation, especially in settings where this care is encountered infrequently. The Acute Care of at-Risk Newborns (ACoRN) program was developed to bridge such gaps. In ACoRN, an initial Primary Survey and systems-based care pathways (Sequences) prioritize and guide the assessment, essential care, and management of at-risk or unwell newborns in the first hours and days of life. This practice point highlights changes to practice and recommendations since 2012, when the ACoRN text and program were last revised. Like NRP, ACoRN is administered in Canada by the Canadian Paediatric Society (CPS). A newly revised and updated textbook and teaching program, both launched in 2021, will standardize care, increase competence and confidence among perinatal care providers, and improve neonatal outcomes in Canada and elsewhere in years to come. [ABSTRACT FROM AUTHOR]

Paediatric practitioners interact with industry representatives for many purposes but most often to receive information on new and existing products. While practitioners believe they are immune to the marketing influences exerted by these representatives, research has demonstrated otherwise. The literature suggests that the public is aware of such influences and that most people feel industry influence on practitioners is inappropriate. National guidelines go some way toward regulating practitioner-industry interactions, although they are not always clear or sufficient. The present practice point explores the context for these relationships, raises some ethical issues specific to paediatric practitioners and provides recommendations for maintaining professional integrity in the patient-physician relationship. Paediatric practitioners have a professional duty to ensure that their own interactions with industry are conducted with the best interests of the patient front and centre. [ABSTRACT FROM AUTHOR]

Les praticiens en pédiatrie interagissent avec des représentants de l'industrie pour bien des motifs, mais la plupart du temps, ils recherchent de l'information sur les nouveaux produits et ceux déjà existants. Ils se pensent à l'abri des influences publicitaires qu'exercent ces représentants, mais les recherches démontrent qu'il en est autrement. D'après les publications, la population est au courant de ces influences, et la plupart des gens les trouvent inappropriées. Les lignes directrices nationales contribuent jusqu'à un certain point à réglementer les interactions entre les praticiens et l'industrie, mais elles ne sont pas toujours claires ni suffisantes. Le présent point de pratique aborde le contexte de ces relations, soulève certains enjeux déontologiques propres aux praticiens en pédiatrie et contient des recommandations pour assurer le maintien de l'intégrité professionnelle dans le cadre de la relation entre le patient et le médecin. Dans leurs interactions avec l'industrie, les praticiens en pédiatrie ont le devoir professionnel de respecter, d'abord et avant tout, l'intérêt du patient. [ABSTRACT FROM AUTHOR]

The use of blogs, Facebook and similar social networking sites is rapidly expanding and, when compared with e-mail, may be having a significantly different impact on the traditional doctor-patient relationship. Characteristics specific to these online platforms have major implications for professional relationships, including the 'Facebook effect' (the relative permanence of postings) and the 'online disinhibi-tion effect'. The present practice point illustrates relevant ethical considerations and provides guidance to paediatricians and others concerning the prudent professional and personal use of social networking media. [ABSTRACT FROM AUTHOR]

We report a term neonate who initially presented with features of Hirschsprung's disease and insidious features of abnormal ventilation that lead to the eventual genetic diagnosis of Congenital Central Hypoventilation Syndrome (CCHS). This case report seeks to highlight the heterogeneity of the respiratory phenotype of CCHS, the limitations of saturation monitoring in detecting ventilation anomalies, and the importance of a high index of suspicion of CCHS when Hirschsprung's disease and ventilatory anomalies are noted in the same patient. [ABSTRACT FROM AUTHOR]

The article offers information on the factor that are important in becoming a phenomenal leader. The suggestions include, motivation, awareness and tolerance. It mentions that motivation is an important part of successful enterprise. It mentions that typical motivators include money, time and power. It mentions that the tolerance is the ability to respect the views of others.

Introduction: Pharmacovigilance programs protect patient health and safety by identifying adverse event signals through postmarketing surveillance of claims data and spontaneous reports. Electronic health records (EHRs) provide new opportunities to address limitations of traditional approaches and promote discovery-oriented pharmacovigilance. Methods: To evaluate the current state of EHR-based medication safety signal identification, we conducted a scoping literature review of studies aimed at identifying safety signals from routinely collected patient-level EHR data. We extracted information on study design, EHR data elements utilized, analytic methods employed, drugs and outcomes evaluated, and key statistical and data analysis choices. Results: We identified 81 eligible studies. Disproportionality methods were the predominant analytic approach, followed by data mining and regression. Variability in study design makes direct comparisons difficult. Studies varied widely in terms of data, confounding adjustment, and statistical considerations. Conclusion: Despite broad interest in utilizing EHRs for safety signal identification, current efforts fail to leverage the full breadth and depth of available data or to rigorously control for confounding. The development of best practices and application of common data models would promote the expansion of EHR-based pharmacovigilance. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Non‐immune hydrops is a prenatal finding which can occur due to an underlying genetic diagnosis such as common chromosomal aneuploidy (Trisomy 21, Turner syndrome etc.). It is extremely rare to have more than one genetic cause of hydrops fetalis in a single pregnancy. This report describes a dichorionic diamniotic pregnancy for a consanguineous couple where noninvasive prenatal testing was "high risk" for Trisomy 21. Family declined amniocentesis and opted for postnatal genetic testing. The pregnancy was later complicated with severe hydrops fetalis leading to demise for one of the twins, and a premature delivery of the other twin who had remarkable collodion not in keeping with Trisomy 21. Postnatal genetic investigations confirmed both Trisomy 21 and prenatal lethal Gaucher disease in the survivor twin. This case report highlights some of the prenatal diagnostic challenges for a consanguineous couple where a rare cause of fetal hydrops was concealed in a setting of a common chromosomal aneuploidy. The prompt postnatal diagnosis of perinatal lethal Gaucher disease, confirmed with undetectable glucocerebrosidase enzyme activity, assisted the family in the decision of providing palliative care for their infant who was quickly deteriorating. The importance of postnatal genetic evaluation and its impact on immediate patient management in an NICU setting is emphasized. This dual diagnosis was significant for the couple as it explained pervious pregnancy losses and has important future recurrence risk implications. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The study's purpose was to assess efficacy of blended learning to decrease stress and burnout among nurses through use of the Stress Management and Resiliency Training (SMART) program. BACKGROUND: Job-related stress in nurses leads to high rates of burnout, compromises patient care, and costs US healthcare organizations billions of dollars annually. Many mindfulness and resiliency programs are taught in a format that limits nurses' attendance. METHODS: Consistent with blended learning, participants chose the format that met their learning styles and goals; Web-based, independent reading, facilitated discussions. The end points of mindfulness, resilience, anxiety, stress, happiness, and burnout were measured at baseline, postintervention, and 3-month follow-up to examine within-group differences. RESULTS: Findings showed statistically significant, clinically meaningful decreases in anxiety, stress, and burnout and increases in resilience, happiness, and mindfulness. CONCLUSIONS: Results support blended learning using SMART as a strategy to increase access to resiliency training for nursing staff. [ABSTRACT FROM AUTHOR]

The article presents a study on the exposure of neonatal registered nurses to moral distress when deciding on resuscitating extremely premature infants. Topics discussed include the factors that contribute to neonatal nurses' experience of moral distress such as clinical environment, treatment procedures and ethical choices, how aspects such as anxiety, depression and fatigue contribute to moral distress, and the impact of technological innovations on the survival rate of premature infants.

Background: Globally 70.8 million people have been forcibly displaced from their homes and are at disproportionally high risk for trauma. At the time of this study, there was an estimated 1.6 million internally displaced persons (IDP) in Iraq, more than two-thirds of whom reside in private, urban settings. This study aims to understand the impact of post-displacement accommodation on mental well-being of the Yazidi minority group displaced in Iraq.Methods: Multi-stage stratified sampling was used to randomly select IDPs in camp and out of camp settlements in northern Iraq. Standardized questionnaires evaluated factors including exposure to violence and self-reported distress symptoms (measured by Impact of Event Scale-Revised). A multi-variate linear model assessed the relationship between settlement setting and distress symptoms.Results: One thousand two hundred fifty-six displaced Yazidi participants were included in the study: 63% in camps and 37% out of camps. After controlling for exposure to violence, social cohesion, unemployment, and access to basic services, IDPs in camps were predicted to have a 19% higher mean distress symptom score compared to those out of camps.Conclusions: This study provides a framework to investigate post-displacement accommodation as a potential intervention to improve well-being for displaced populations. With a shift towards new models of emergency and long-term housing, it is important to understand the potential and limitations of more decentralized models, and identify effective methods to maintain access to basic services while improving living conditions for both displaced populations and their host communities. [ABSTRACT FROM AUTHOR]

Patients with psychosis can have poor insight into their illness. This study examined the feasibility, safety, and efficacy of using video self-observation (VSO) to improve insight in hospitalized adolescent and young adult patients with psychosis. [Extracted from the article]

Background and objectives Hypoglycemia monitoring is not recommended for most full-term newborns. We wished to determine the incidence, presentation and case characteristics of hypoglycemia in low-risk newborns. Methods With the assistance of the Canadian Paediatric Surveillance Program, we conducted a national study of severe hypoglycemia in apparently low-risk full-term newborns. Paediatricians who reported a case were sent a detailed questionnaire and the data were analyzed. Results: All 93 confirmed cases were singletons, 56% were first-borns and 65% were male. An 8% rate of First Nations cases was twofold the population rate. Maternal hypertension rate was 23%, fourfold the general pregnancy rate. Maternal obesity was double the general pregnancy rate at 23%. Concerning signs or feeding issues were noted in 98% at the time of diagnosis. Median time to diagnosis was 4.1 hours. Mean blood glucose at intravenous (IV) start was 1.4 ± 0.5 hours (SD). Seventy-eight per cent had at least one of four potential stress indicators and were more likely to have early diagnosis (P=0.03). Major signs were present in 20%. Those cases presented later and had lower glucose levels (median=0.8 mmol/L versus 1.6 mmol/L, [P<0.001). Twenty-five per cent of cases had birth weight less than the 10th centile. Neurodevelopmental concern was reported in 20%. Of the 13 cases which had brain magnetic resonance imaging, 11 were abnormal. Conclusion Hypoglycemia in unmonitored newborns is uncommon but is associated with significant morbidity. We provide a range of clues to help identify these newborns soon after birth. Widespread adoption of norm-based standards to identify small-for-gestational age infants is supported. [ABSTRACT FROM AUTHOR]

We present evidence of the gravitational lensing of the cosmic microwave background by 1013 solar mass dark matter halos. Lensing convergence maps from the Atacama Cosmology Telescope Polarimeter (ACTPol) are stacked at the positions of around 12000 optically selected CMASS galaxies from the SDSS-III/BOSS survey. The mean lensing signal is consistent with simulated dark matter halo profiles and is favored over a null signal at 3.2σ significance. This result demonstrates the potential of microwave background lensing to probe the dark matter distribution in galaxy group and galaxy cluster halos. [ABSTRACT FROM AUTHOR]

A correction to the article "Evidence of Lensing of the Cosmic Microwave Background" that was published online in the April 13, 2015 issue is presented.