المؤلفون: Katie O’Hearn, Kusum Menon, Hope A. Weiler, Karin Amrein, Dean Fergusson, Anna Gunz, Raul Bustos, Roberto Campos, Valentina Catalan, Siegfried Roedl, Anne Tsampalieros, Nick Barrowman, Pavel Geier, Matthew Henderson, Ali Khamessan, Margaret L. Lawson, Lauralyn McIntyre, Stephanie Redpath, Glenville Jones, Martin Kaufmann, Dayre McNally, the Canadian Critical Care Trials Group

المصدر: BMC Pediatrics, Vol 23, Iss 1, Pp 1-16 (2023)

مصطلحات موضوعية: Vitamin D, Pediatrics, Critical care, Feasibility, Randomized controlled trial, Vitamin D deficiency, RJ1-570

الوصف: Abstract Background Vitamin D deficiency (VDD) is highly prevalent in the pediatric intensive care unit (ICU) and associated with worse clinical course. Trials in adult ICU demonstrate rapid restoration of vitamin D status using an enteral loading dose is safe and may improve outcomes. There have been no published trials of rapid normalization of VDD in the pediatric ICU. Methods We conducted a multicenter placebo-controlled phase II pilot feasibility randomized clinical trial from 2016 to 2017. We randomized 67 critically ill children with VDD from ICUs in Canada, Chile and Austria using a 2:1 randomization ratio to receive a loading dose of enteral cholecalciferol (10,000 IU/kg, maximum of 400,000 IU) or placebo. Participants, care givers, and outcomes assessors were blinded. The primary objective was to determine whether the loading dose normalized vitamin D status (25(OH)D > 75 nmol/L). Secondary objectives were to evaluate for adverse events and assess the feasibility of a phase III trial. Results Of 67 randomized participants, one was withdrawn and seven received more than one dose of cholecalciferol before the protocol was amended to a single loading dose, leaving 59 participants in the primary analyses (40 treatment, 19 placebo). Thirty-one/38 (81.6%) participants in the treatment arm achieved a plasma 25(OH)D concentration > 75 nmol/L versus 1/18 (5.6%) the placebo arm. The mean 25(OH)D concentration in the treatment arm was 125.9 nmol/L (SD 63.4). There was no evidence of vitamin D toxicity and no major drug or safety protocol violations. The accrual rate was 3.4 patients/month, supporting feasibility of a larger trial. A day 7 blood sample was collected for 84% of patients. A survey administered to 40 participating families showed that health-related quality of life (HRQL) was the most important outcome for families for the main trial (30, 75%). Conclusions A single 10,000 IU/kg dose can rapidly and safely normalize plasma 25(OH)D concentrations in critically ill children with VDD, but with significant variability in 25(OH)D concentrations. We established that a phase III multicentre trial is feasible. Using an outcome collected after hospital discharge (HRQL) will require strategies to minimize loss-to-follow-up. Trial Registration. Clinicaltrials.gov NCT02452762 Registered 25/05/2015.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2431Test

الوصول الحر: https://doaj.org/article/4c8419e5fc154ede87679b8addf370ffTest

المؤلفون: Margaret L. Lawson, Allyson L. Shephard, Bryan Feenstra, Laura Boland, Nadia Sourial, Dawn Stacey

المصدر: BMC Pediatrics, Vol 20, Iss 1, Pp 1-8 (2020)

مصطلحات موضوعية: Shared decision making, Decision coaching, Patient decision aid, Decisional conflict, Type I diabetes, Pediatrics, RJ1-570

الوصف: Abstract Background Choice of insulin delivery for type 1 diabetes can be difficult for many parents and children. We evaluated decision coaching using a patient decision aid for helping youth with type 1 diabetes and parents decide about insulin delivery method. Methods A pre/post design. Youth and parent(s) attending a pediatric diabetes clinic in a tertiary care centre were referred to the intervention by their pediatric endocrinologist or diabetes physician between September 2013 and May 2015. A decision coach guided youth and their parents in completing a patient decision aid that was pre-populated with evidence on insulin delivery options. Primary outcomes were youth and parent scores on the low literary version of the validated Decisional Conflict Scale (DCS). Results Forty-five youth (mean age = 12.5 ± 2.9 years) and 66 parents (45.8 ± 5.6 years) participated. From pre- to post-intervention, youth and parent decisional conflict decreased significantly (youth mean DCS score was 32.0 vs 6.6, p

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2431Test

الوصول الحر: https://doaj.org/article/589ddc1d358349a6a026c3c87312ff9bTest

المؤلفون: Laura Boland, Jennifer Kryworuchko, Anton Saarimaki, Margaret L. Lawson

المصدر: BMC Pediatrics, Vol 17, Iss 1, Pp 1-8 (2017)

مصطلحات موضوعية: Pediatrics, Parents, Decisional conflict, Shared decision making, Family centered care, RJ1-570

الوصف: Abstract Background Decisional conflict is a state of uncertainty about the best treatment option among competing alternatives and is common among adult patients who are inadequately involved in the health decision making process. In pediatrics, research shows that many parents are insufficiently involved in decisions about their child’s health. However, little is known about parents’ experience of decisional conflict. We explored parents’ perceived decision making involvement and its association with parents’ decisional conflict. Method We conducted a descriptive survey study in a pediatric tertiary care hospital. Our survey was guided by validated decisional conflict screening items (i.e., the SURE test). We administered the survey to eligible parents after an ambulatory care or emergency department consultation for their child. Results Four hundred twenty-nine respondents were included in the analysis. Forty-eight percent of parents reported not being offered treatment options and 23% screened positive for decisional conflict. Parents who reported being offered options experienced less decisional conflict than parents who reported not being offered options (5% vs. 42%, p

وصف الملف: electronic resource

العلاقة: http://link.springer.com/article/10.1186/s12887-017-0899-4Test; https://doaj.org/toc/1471-2431Test

الوصول الحر: https://doaj.org/article/49b88ea671a948bc95657ad62c2de248Test

المؤلفون: Bryan Feenstra, Dawn Stacey, Laura Boland, Margaret L. Lawson, Nadia Sourial, Allyson Shephard

المصدر: BMC Pediatrics, Vol 20, Iss 1, Pp 1-8 (2020)
BMC Pediatrics

مصطلحات موضوعية: Parents, medicine.medical_specialty, Decisional conflict, Adolescent, Decision Making, MEDLINE, Insulin delivery, Coaching, Tertiary care, Decision Support Techniques, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Intervention (counseling), Diabetes mellitus, Type I diabetes, medicine, Humans, Insulin, 030212 general & internal medicine, Child, Shared decision making, Type 1 diabetes, business.industry, 4. Education, lcsh:RJ1-570, Mentoring, lcsh:Pediatrics, medicine.disease, Patient decision aid, Diabetes Mellitus, Type 1, Family medicine, Pediatrics, Perinatology and Child Health, business, Decision coaching, Research Article

الوصف: Background Choice of insulin delivery for type 1 diabetes can be difficult for many parents and children. We evaluated decision coaching using a patient decision aid for helping youth with type 1 diabetes and parents decide about insulin delivery method. Methods A pre/post design. Youth and parent(s) attending a pediatric diabetes clinic in a tertiary care centre were referred to the intervention by their pediatric endocrinologist or diabetes physician between September 2013 and May 2015. A decision coach guided youth and their parents in completing a patient decision aid that was pre-populated with evidence on insulin delivery options. Primary outcomes were youth and parent scores on the low literary version of the validated Decisional Conflict Scale (DCS). Results Forty-five youth (mean age = 12.5 ± 2.9 years) and 66 parents (45.8 ± 5.6 years) participated. From pre- to post-intervention, youth and parent decisional conflict decreased significantly (youth mean DCS score was 32.0 vs 6.6, p p Conclusion Decision coaching with a patient decision aid reduced decisional conflict for youth and parents facing a decision about insulin delivery method.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::40f3255c8b502dbdbe39d5171eb4cfc8Test
https://doi.org/10.1186/s12887-019-1898-4Test

المؤلفون: Cynthia J Downie, Cheril Clarson, Jacqueline R Curtis, Brenda Bradley, Susan E. Kirsch, Jennilea Courtney, Nick Barrowman, Christine Richardson, Karen McAssey, Gopalan Rajamannar, Margaret L. Lawson, Tammy Cooper, Farid H. Mahmud

المصدر: BMC Pediatrics
Paediatrics Publications

مصطلحات موضوعية: Blood Glucose, Male, Research design, Pediatrics, Time Factors, endocrine system diseases, Adolescents, law.invention, Study Protocol, Randomized controlled trial, law, Insulin, Prospective Studies, Child, Prospective cohort study, Continuous glucose monitoring, Children, Infusion Pumps, Implantable, Intention to Treat Analysis, Treatment Outcome, Type 1 diabetes, Research Design, Child, Preschool, Female, Quality of life, Insulin pump, medicine.medical_specialty, Adolescent, Continuous subcutaneous insulin infusion, Insulin Infusion Systems, Diabetes mellitus, medicine, Humans, Hypoglycemic Agents, Pediatrics, Perinatology, and Child Health, Glycemic, Glycated Hemoglobin, Treatment satisfaction, Intention-to-treat analysis, business.industry, Blood Glucose Self-Monitoring, Patient Selection, nutritional and metabolic diseases, Glycosylated hemoglobin, medicine.disease, Diabetes Mellitus, Type 1, Logistic Models, Adherence, Pediatrics, Perinatology and Child Health, Linear Models, Patient Compliance, business, Biomarkers, Follow-Up Studies

الوصف: Background: Continuous glucose monitoring (CGM) has been shown to improve glucose control in adults with type 1 diabetes. Effectiveness of CGM is directly linked with CGM adherence, which can be challenging to maintain in children and adolescents. We hypothesize that initiating CGM at the same time as starting insulin pump therapy in pump naïve children and adolescents with type 1 diabetes will result in greater CGM adherence and effectiveness compared to delaying CGM introduction by 6 months, and that this is related to greater readiness for making behaviour change at the time of pump initiation.Methods/Design: The CGM TIME Trial is a multicenter randomized controlled trial. Eligible children and adolescents (5-18 years) with established type 1 diabetes were randomized to simultaneous initiation of pump (Medtronic Veo©) and CGM (Enlite©) or to standard pump therapy with delayed CGM introduction. Primary outcomes are CGM adherence and hemoglobin A1C at 6 and 12 months post pump initiation. Secondary outcomes include glycemic variability, stage of readiness, and other patient-reported outcomes with follow-up to 24 months. 144 (95%) of the 152 eligible patients were enrolled and randomized. Allowing for 10% withdrawals, this will provide 93% power to detect a between group difference in CGM adherence and 86% power to detect a between group difference in hemoglobin A1C. Baseline characteristics were similar between the treatment groups. Analysis of 12 month primary outcomes will begin in September 2014.Discussion: The CGM TIME Trial is the first study to examine the relationship between timing of CGM initiation, readiness for behaviour change, and subsequent CGM adherence in pump naïve children and adolescents. Its findings will advance our understanding of when and how to initiate CGM in children and adolescents with type 1 diabetes.Trial registration: ClinicalTrial.gov NCT01295788. Registered 14 February 2011. © 2014 Lawson et al.; licensee BioMed Central Ltd.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3a4991d9f698befc36782d9c66110439Test
https://doi.org/10.1186/1471-2431-14-183Test

المؤلفون: Tamara Spaic, Tracy Robinson, Nicole Byers, Margaret L. Lawson, Jeff Mahon, Irene Hramiak, Ellen B. Goldbloom, Keira Evans, Janine Malcolm, Cheril Clarson

المصدر: BMC Pediatrics
Paediatrics Publications

مصطلحات موضوعية: Male, medicine.medical_specialty, Transition to Adult Care, Adolescent, Population, Chronic illness, law.invention, Study Protocol, Young Adult, Patient satisfaction, Randomized controlled trial, Transition care, Clinical Protocols, law, Diabetes mellitus, Medicine, Humans, Transition intervention, Pediatrics, Perinatology, and Child Health, Disease management (health), Young adult, Lost to follow-up, education, education.field_of_study, Type 1 diabetes, business.industry, Healthcare systems, Disease Management, Continuity of Patient Care, medicine.disease, Adolescents and young adults, Diabetes Mellitus, Type 1, Patient Satisfaction, Pediatrics, Perinatology and Child Health, Emergency medicine, Physical therapy, Regression Analysis, Female, Lost to Follow-Up, business, Program Evaluation

الوصف: Background: Transition from pediatric to adult diabetes care is a high risk period during which there is an increased rate of disengagement from care. Suboptimal transition has been associated with higher risks for acute and chronic diabetes-related complications. The period of emerging adulthood challenges current systems of healthcare delivery as many young adults with type 1 diabetes (T1D) default from diabetes care and are at risk for diabetes complications which are undetected and therefore untreated. Despite the importance of minimizing loss to follow-up there are no randomized control trials evaluating models of transition from pediatric to adult diabetes care.Methods/Design: This is a multicentre randomized controlled trial. A minimum of 188 subjects with T1D aged between 17 and 20 years will be evaluated. Eligible subjects will be recruited from three pediatric care centres and randomly assigned in a 1:1 ratio to a structured transition program that will span 18 months or to receive standard diabetes care. The structured transition program is a multidisciplinary, complex intervention aiming to provide additional support in the transition period. A Transition Coordinator will provide transition support and will provide the link between pediatric and adult diabetes care. The Transition Coordinator is central to the intervention to facilitate ongoing contact with the medical system as well as education and clinical support where appropriate. Subjects will be seen in the pediatric care setting for 6 months and will then be transferred to the adult care setting where they will be seen for one year. There will then be a one-year follow-up period for outcome assessment. The primary outcome is the proportion of subjects who fail to attend at least one outpatient adult diabetes specialist visit during the second year after transition to adult diabetes care. Secondary outcome measures include A1C frequency measurement and levels, diabetes related emergency room visits and hospital admissions, frequency of complication screening, and subject perception and satisfaction with care.Discussion: This trial will determine if the support of a Transition Coordinator improves health outcomes for this at-risk population of young adults.Trial registration: Trial Registration Number: NCT01351857. © 2013 Spaic et al.; licensee BioMed Central Ltd.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::33f1321b421725efbdf3a09c343d4cb9Test
http://europepmc.org/articles/PMC3879408Test

المؤلفون: Bryan Feenstra, Denise Harrison, Jennifer Kryworuchko, Laura Boland, Michelle Leblanc, Margaret L. Lawson, Dawn Stacey

المصدر: BMC Pediatrics

مصطلحات موضوعية: Practice, medicine.medical_specialty, Adolescent, business.industry, Decision Making, education, Psychological intervention, MEDLINE, Decision quality, Social Support, CINAHL, PsycINFO, Cochrane Library, Social support, Family medicine, Pediatrics, Perinatology and Child Health, medicine, Humans, Patient participation, Pediatrics, Perinatology, and Child Health, Child, Psychiatry, business, Research Article

الوصف: Background Children often need support in health decision-making. The objective of this study was to review characteristics and effectiveness of interventions that support health decision-making of children. Methods A systematic review. Electronic databases (PubMed, the Cochrane Library, Web of Science, Scopus, ProQuest Dissertations and Theses, CINAHL, PsycINFO, MEDLINE, and EMBASE) were searched from inception until March 2012. Two independent reviewers screened eligibility: a) intervention studies; b) involved supporting children (≤18 years) considering health-related decision(s); and c) measured decision quality or decision-making process outcomes. Data extraction and quality appraisal were conducted by one author and verified by another using a standardized data extraction form. Quality appraisal was based on the Cochrane Risk of Bias tool. Results Of 4313 citations, 5 studies were eligible. Interventions focused on supporting decisions about risk behaviors (n = 3), psycho-educational services (n = 1), and end of life (n = 1). Two of 5 studies had statistically significant findings: i) compared to attention placebo, decision coaching alone increased values congruence between child and parent, and child satisfaction with decision-making process (lower risk of bias); ii) compared to no intervention, a workshop with weekly assignments increased overall decision-making quality (higher risk of bias). Conclusions Few studies have focused on interventions to support children’s participation in decisions about their health. More research is needed to determine effective methods for supporting children’s health decision-making.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5daa731bbfc287ab3d747ce2dbd913c5Test