Pédiatrie // Pediatrics

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Bibliometric Analysis of Neurology Articles Published in General Medicine Journals
(2021) Wilson, Mitch; Sampson, Margaret; Barrowman, Nick; Doja, Asif
Importance A significant portion of neurology literature is published in general medicine journals. Despite this, a detailed examination of publication patterns of neurology articles in these journals has not yet been carried out. Objective To examine the publication patterns of neurology articles in general medicine journals during a 10-year period using a bibliometric approach. Design, Setting, and Participants This cross-sectional bibliometric analysis identified the top 5 general medicine journals using the 2017 Journal Citations Report. Four other medical subspecialties (ie, immunology, endocrinology, gastroenterology, and pulmonology) were selected for comparison of publication patterns with neurology. Using MEDLINE, the 5 journals were searched for articles published between 2009 and 2018 that were indexed with the following MeSH terms: nervous system diseases, immune system diseases, endocrine system diseases, gastrointestinal diseases, and respiratory tract diseases. Data analysis was conducted from February 2019 to December 2020. Main Outcomes and Measures Publications were characterized by journal, specialty, and study design. These variables were used for comparison of publication numbers. Results The general medicine journals with the 5 highest journal impact factors (JIF) were New England Journal of Medicine (NEJM; JIF 79.3), Lancet (JIF 53.3), JAMA (JIF 47.7), BMJ (JIF 23.6), and PLOS Medicine (JIF 11.7). Our bibliometric search yielded 3719 publications, of which 1098 (29.5%) were in neurology. Of these 1098 neurology publications, 317 (28.9%) were published in NEJM, 205 (18.7%) in Lancet, 284 (25.9%) in JAMA, 214 (19.5%) in BMJ, and 78 (7.1%) in PLOS Medicine. Randomized clinical trials were the most frequent neurology study type in general medicine journals (519 [47.3%]). The number of publications in each of the other specialties were as follows: immunology, 817; endocrinology, 633; gastroenterology, 353; and pulmonology, 818. Conclusions and Relevance The results of this study provide some guidance to authors regarding where they may wish to consider submitting their neurology research. Compared with other specialties, neurology-based articles are published more frequently in general medicine journals.
Hemifacial Spasm in Mucopolysaccharidosis Type VI (Maroteaux-Lamy Syndrome)
(2018) Karir, Aneesh; Geraghty, Michael; Vassilyadi, Michael; Doja, Asif
Hemifacial spasms are involuntary contractions of the muscles of one side of the face.
Exploring Trainees' Needs in order to Develop a Training Program in Neonatal Resuscitation
(2017-03-17) Ben Fadel, Nadya; Moore, Gregory; Lawrence, Sarah L; Daboval, Thierry; Ferretti, Emanuela; Rouvinez-Bouali, Nicole
A retrospective review of trainees’ performance in neonatal mock codes identified deficiencies in their skills. Initiatives to create a new curriculum to improve training in this area included surveying trainees to assess their attitudes towards neonatal resuscitation training, perceived skill deficit and preferred learning strategies. Methods: An online survey was sent to fifty trainees enrolled in the pediatrics program at the University of Ottawa. Results: Seventy six percent of trainees responded. All respondents agreed on the importance of the ability to run a real or mock code. Only 11% of trainees were very comfortable performing a real resuscitation by the end of their first year of training; while 23% were very comfortable when running mock codes. From the different learning strategies presented to them, most trainees preferred hands-on experience (i.e. mock codes). Conclusion: Most trainees believed they weren’t adequately prepared and weren’t comfortable running a real or mock neonatal resuscitation. Information gathered from this survey guided us in developing a new training program to enhance trainees’ skill level and comfort in both mock code and real neonatal resuscitation.
An Evaluation of a Gentamicin Dosing Protocol in the Treatment of Bacterial Infections in Neonates
(2016-03-21) Ponnuthurai, Johanna; Varughese, Nisha; Laframboise, Claire; Lauzon, Léna; Pouliot, Annie; Lemyre, Brigitte
Objective: To determine the safety and efficacy of a revised gentamicin dosing regimen. Study Design: Retrospective study of neonates ≤ 1 month corrected gestational age and admitted to one of 3 Neonatal Units between June 1and December 31, 2012. The primary outcome was trough levels ≤2 mg/L. Result: 151 neonates (mean 33.5 weeks) were included. 80% of patients had a trough level ≤2 mg/L while 94% had peak levels of 5-10 mg/L. The majority of trough levels >2 mg/L were in infants 29-36 weeks corrected and ≤14 days and in term babies ≤7 days of age. Lower gestational age and lower 1 and 5 minute Apgar scores were associated with a high trough. Conclusion: Our gentamicin dosing regimen is suboptimal for moderately preterm neonates who are ≤14 days and term infants ≤7 days. Further research is needed to determine the most effective gentamicin dosing regimen, particularly in preterm neonates.
Growth curves in short supply: a descriptive study of the availability and utility of growth curve data in adolescents with eating disorders
(2013) Harrison, Megan E; Obeid, Nicole; Fu, Maeghan C Y; Norris, Mark L
Healthy body weight (HBW) determination affects multiple aspects of eating disorder (ED) treatment. For example, it can inform patients and providers as to when return of menses (ROM), an objective determinant of health, can occur. Growth curves (GCs) are sensitive indicators of health in youth and when up to date provide critical information regarding normal and expected trajectories of growth. Although not widely recommended as a first line tool for HBW calculation, a GC guides providers selecting a HBW that is individualized to each patient. The primary aim of this paper was to assess availability and feasibility of utilizing GC data for HBW prediction in adolescents referred for an ED assessment. We also sought to determine how this calculation compared to the standardized HBW calculation that uses mean body mass index (BMI) for age and how each of these numbers compared to the actual weight at ROM.
Accuracy of physical examination versus ultrasound in the detection of hepatosplenomegaly at diagnosis of pediatric leukemia
(2013-06-27) Cyr, Janelle; Johnston, Donna L.
Background: Hepatosplenomegaly (HSM) is common at diagnosis of pediatric leukemia and is diagnosed through palpation or ultrasound. We sought to determine if ultrasound was necessary. Methods: Spleen and liver size was recorded from palpation and ultrasound for 94 children with a new diagnosis of leukemia. Results: Palpation was correct in detecting 71% (173/245) of cases of splenomegaly and 68% (172/254) of cases of hepatomegaly. There was no relationship between body mass index and clinician accuracy at diagnosis of HSM. Ultrasound examination had abnormal findings excluding HSM in 56% of patients. Conclusions: Ultrasound examination is a warranted investigation for newly diagnosed children with leukemia.
The association between accelerometer-measured patterns of sedentary time and health risk in children and youth: results from the Canadian Health Measures Survey
(2013-05-29) Colley, Rachel C; Garriguet, Didier; Janssen, Ian; Wong, Suzy L; Saunders, Travis J; Carson, Valerie; Tremblay, Mark S
Background: Self-reported screen time is associated with elevated health risk in children and youth; however, research examining the relationship between accelerometer-measured sedentary time and health risk has reported mixed findings. The purpose of this study was to examine the association between accelerometer-measured patterns of sedentary time and health risk in children and youth. Methods: The results are based on 1,608 children and youth aged 6 to 19 years from the Canadian Health Measures Survey (2007–2009). Sedentary time was measured using the Actical accelerometer. Breaks in sedentary time and prolonged bouts of sedentary time lasting 20 to 120 minutes were derived for all days, weekend days and during the after-school period (i.e., after 3 pm on weekdays). Regression analyses were used to examine the association between patterns of sedentary time and body mass index (BMI), waist circumference, blood pressure and non-HDL cholesterol. Results: Boys accumulated more sedentary time on weekdays after 3 pm and had a higher number of breaks in sedentary time compared to girls. Overweight/obese boys (aged 6–19 years) accumulated more sedentary time after 3 pm on weekdays (282 vs. 259 min, p < .05) and as prolonged bouts lasting at least 80 minutes (171 vs. 133 min, p < .05) compared to boys who were neither overweight nor obese. Prolonged bouts of sedentary time lasting at least 80 minutes accumulated after 3 pm on weekdays were positively associated with BMI and waist circumference in boys aged 11–14 years (p < .006). Each additional 60 min of sedentary time after 3 pm on weekdays was associated with a 1.4 kg·m-2 higher BMI and a 3.4 cm higher waist circumference in 11–14 year old boys. No sedentary pattern variables differed between girls who were not overweight or obese and those who were overweight/obese and none of the sedentary pattern variables were associated with any health markers in girls. Conclusions: The findings confirm results of other studies that reported accelerometer-measured sedentary time was not associated with health risk in children and youth. Even when the pattern and timing of sedentary time was examined relative to health markers, few associations emerged and were limited to boys aged 11–14 years.
Mental Work Stimulates Cardiovascular Responses through a Reduction in Cardiac Parasympathetic Modulation in Men and Women
(2012-08-24) Pérusse-Lachance, Emilie; Tremblay, Angelo; Chaput, Jean-Philippe; Poirier, Paul; Teasdale, Normand; Drapeau, Vicky; Sénécal, Caroline; Brassard, Patrice
Mental Work (MW) stimulates Cardiovascular (CV) functions in healthy adults and a reduction in cardiac parasympathetic modulation could be one mechanism involved in such a response. The influence of sex on these CV responses remains ambiguous. The aim of the study was to evaluate CV impacts of MW in healthy individuals and whether sex influences CV responses induced by MW. The impact of a 45-min reading and writing session vs. a control condition, on Blood Pressure (BP), Heart Rate (HR), and Heart Rate Variability (HRV), was evaluated in 44 healthy adults with the use of a randomized crossover design. The influence of sex on those variables was then evaluated. Diastolic BP (74 ± 1 vs. 69 ± 1 mm Hg; p < 0.05) and mean arterial pressure (MAP; 87 ± 7 vs. 83 ± 8 mmHg; p < 0.005), HR (68 ± 1 vs. 62 ± 1 bpm; p < 0.0001) and low frequency/high frequency ratio (2.8 ± 0.1 vs. 2.0 ± 0.1; p < 0.0001) were higher, while global HRV (SDNN: 84 ± 3 vs.104 ± 3 ms; p < 0.0001) and cardiac parasympathetic activity were lower during MW (p < 0.0001) vs. the control condition in the whole sample. During both experimental conditions, HR was higher (p < 0.0001), while BP, rMSSD, pNN50 and low frequency component of HRV were lower in women compared to men (all p < 0.05). The intensity of the cognitive demand and its influence on CV variables were comparable between men and women. These results support that MW increases BP and HR through decrement in cardiac parasympathetic modulation in healthy subjects and suggest that sex does not influence CV responses induced by cognitive demand of similar intensity.
A case of a young girl with Myelodysplastic Syndrome (MDS), dysmorphic features, short stature, and developmental delay – Is there a link?
(2012-08-24) Parker, Torrey M.; Bassal, Mylene; Klaassen, Robert; Nikkel, Sarah M.; Cada, Michaela; Johnston, Donna L.
Myelodysplastic Syndrome (MDS) is a problem of ineffective hematopoesis, due to a clonal disorder of the hematopoetic stem cells. MDS is rare in children and considered premalignant as it often progresses to leukemia over time. There are known inherited predisposing conditions to MDS that have been reported in the literature. We describe the case of a 12-year-old girl with multiple dysmorphic features, short stature, and developmental delay with a new diagnosis of MDS (RAEB) with no confirmed genetic diagnosis linking all these features together. We propose that her underlying syndromic diagnosis may have predisposed her to MDS.
IRES-mediated Translation of Cellular Messenger RNA Operates in eIF2α- independent Manner during Stress
(2011) Thakor, Nehal; Holcik, Martin
Physiological and pathophysiological stress attenuates global translation via phosphorylation of eIF2α. This in turn leads to the reprogramming of gene expression that is required for adaptive stress response. One class of cellular messenger RNAs whose translation was reported to be insensitive to eIF2α phosphorylation-mediated repression of translation is that harboring an Internal Ribosome Entry Site (IRES). IRES-mediated translation of several apoptosis-regulating genes increases in response to hypoxia, serum deprivation or gamma irradiation and promotes tumor cell survival and chemoresistance. However, the molecular mechanism that allows IRES-mediated translation to continue in an eIF2α-independent manner is not known. Here we have used the X-chromosome linked Inhibitor of Apoptosis, XIAP, IRES to address this question. Using toeprinting assay, western blot analysis and polysomal profiling we show that the XIAP IRES supports cap-independent translation when eIF2α is phosphorylated both in vitro and in vivo. During normal growth condition eIF2α-dependent translation on the IRES is preferred. However, IRES-mediated translation switches to eIF5B-dependent mode when eIF2α is phosphorylated as a consequence of cellular stress.
How Strong are Passwords Used to Protect Personal Health Information in Clinical Trials?
(2011-06-21) El Emam, Khaled; Moreau, Katherine; Jonker, Elizabeth
Background: Findings and statements about how securely personal health information is managed in clinical research are mixed. Objective: The objective of our study was to evaluate the security of practices used to transfer and share sensitive files in clinical trials. Methods: Two studies were performed. First, 15 password-protected files that were transmitted by email during regulated Canadian clinical trials were obtained. Commercial password recovery tools were used on these files to try to crack their passwords. Second, interviews with 20 study coordinators were conducted to understand file-sharing practices in clinical trials for files containing personal health information. Results: We were able to crack the passwords for 93% of the files (14/15). Among these, 13 files contained thousands of records with sensitive health information on trial participants. The passwords tended to be relatively weak, using common names of locations, animals, car brands, and obvious numeric sequences. Patient information is commonly shared by email in the context of query resolution. Files containing personal health information are shared by email and, by posting them on shared drives with common passwords, to facilitate collaboration. Conclusion: If files containing sensitive patient information must be transferred by email, mechanisms to encrypt them and to ensure that password strength is high are necessary. More sophisticated collaboration tools are required to allow file sharing without password sharing. We provide recommendations to implement these practices.
A replicated survey of IT software project failures
(2008) El Emam, Khaled; Koru, A. Günes
Despite various industry reports about the failure rates of software projects, there's still uncertainty about the actual figures. Researchers performed a global Web survey of IT departments in 2005 and 2007. The results suggest that the software crisis is perhaps exaggerated and that most software projects deliver. However, the overall project failure rate, including cancelled and completed but poorly performing projects, remains arguably high for an applied discipline. // NOTE // This material is presented to ensure timely dissemination of scholarly and technical work. Copyright and all rights therein are retained by authors or by other copyright holders. All persons copying this information are expected to adhere to the terms and constraints invoked by each author's copyright. In most cases, these works may not be reposted without the explicit permission of the copyright holder.
Heuristics for de-identifying health data
(2008) El Emam, Khaled
Before releasing personal health information for secondary uses, such as research or public health monitoring, organizations must de-identify the data they've collected. Several common heuristics are useful for this purpose, but they also have limitations. // NOTE // This material is presented to ensure timely dissemination of scholarly and technical work. Copyright and all rights therein are retained by authors or by other copyright holders. All persons copying this information are expected to adhere to the terms and constraints invoked by each author's copyright. In most cases, these works may not be reposted without the explicit permission of the copyright holder.
Privacy interests in prescription data, part I: Prescriber privacy
(2009) Kosseim, Patricia; El Emam, Khaled
For several years, concern has been growing about privacy implications that arise from using and disclosing prescription data. Some patterns or practices provide pharmaceutical companies with the historical trends they need to better target their marketing efforts aimed at individual physicians through more intense, precise, and unique detailing strategies. In the first of a two part-article, the authors focus the privacy implications arising from the sale or transfer of prescription data, in respect to prescribers in Canada and the US. // NOTE // This material is presented to ensure timely dissemination of scholarly and technical work. Copyright and all rights therein are retained by authors or by other copyright holders. All persons copying this information are expected to adhere to the terms and constraints invoked by each author's copyright. In most cases, these works may not be reposted without the explicit permission of the copyright holder.
Privacy interests in prescription data, part 2: Patient privacy
(2009) El Emam, Khaled; Kosseim, Patricia
Prescription data disclosed by pharmacies without patient consent, could constitute a breach of privacy if individual patients can be re-identified by third parties. This article analyzes the concept of identifiability under Canadian and US privacy laws, including applicable thresholds of risk and the perspective from which the risk must be examined. The article goes on to examine concrete examples of how the risk of re-identifiability of prescription data can materialize in practice. // NOTE // This material is presented to ensure timely dissemination of scholarly and technical work. Copyright and all rights therein are retained by authors or by other copyright holders. All persons copying this information are expected to adhere to the terms and constraints invoked by each author's copyright. In most cases, these works may not be reposted without the explicit permission of the copyright holder.
The theory of relative dependency: Higher coupling concentration in smaller modules
(2010-07-14T15:58:00Z) Koru, A. Günes; El Emam, Khaled
Recent studies have repeatedly found that smaller modules are proportionally more defect-prone. In this article, the authors formulate and test a hypothesis stating that smaller modules are proportionally more coupled, given that dependencies caused by coupling have been consistently associated with defect-proneness. Strong evidence supports this hypothesis. Furthermore, refactoring exacerbates this effect. On the basis of this study's highly consistent results, the authors state the empirically based theory of relative dependency. That is, in large-scale software systems, smaller modules will be proportionally more dependent compared to larger ones. These findings have two implications for practice. First, we now have an empirically supported mechanism explaining the observations that defect concentration is higher in smaller modules. Practitioners can use this mechanism as evidence while seeking resources and support to revise or amend their organizations' quality assurance and quality control practices. Second, particularly for the projects that refactor extensively, such as those using agile methods, focusing defect detection activities on smaller modules will increase their efficiency and effectiveness even more. // NOTE // This material is presented to ensure timely dissemination of scholarly and technical work. Copyright and all rights therein are retained by authors or by other copyright holders. All persons copying this information are expected to adhere to the terms and constraints invoked by each author's copyright. In most cases, these works may not be reposted without the explicit permission of the copyright holder.
The inadvertent disclosure of personal health information through peer-to-peer file sharing programs
(2010-05-13T19:25:33Z) El Emam, Khaled; Neri, Emilio; Jonker, Elizabeth; Sokolova, Marina; Peyton, Liam; Neisa, Angelica; Scassa, Teresa
Objective: There has been a consistent concern about the inadvertent disclosure of personal information through peer-to-peer file sharing applications, such as Limewire and Morpheus. Examples of personal health and financial information being exposed have been published. We wanted to estimate the extent to which personal health information (PHI) is being disclosed in this way, and compare that to the extent of disclosure of personal financial information (PFI). Design: After careful review and approval of our protocol by our institutional research ethics board, files were downloaded from peer-to-peer file sharing networks and manually analyzed for the presence of PHI and PFI. The geographic region of the IP addresses was determined, and classified as either USA or Canada. Measurement: We estimated the proportion of files that contain personal health and financial information for each region. We also estimated the proportion of search terms that return files with personal health and financial information. We ascertained and discuss the ethical issues related to this study. Results: Approximately 0.4% of Canadian IP addresses had PHI, as did 0.5% of US IP addresses. There was more disclosure of financial information, at 1.7% of Canadian IP addresses and 4.7% of US IP addresses. An analysis of search terms used in these file sharing networks showed that a small percentage of the terms would return PHI and PFI files (ie, there are people successfully searching for PFI and PHI on the peer-to-peer file sharing networks). Conclusion: There is a real risk of inadvertent disclosure of PHI through peer-to-peer file sharing networks, although the risk is not as large as for PFI. Anyone keeping PHI on their computers should avoid installing file sharing applications on their computers, or if they have to use such tools, actively manage the risks of inadvertent disclosure of their, their family's, their clients', or patients' PHI.
Who’s using PDAs? Estimates of PDA use by health care providers: A systematic review of surveys
(2006) Garritty, Chantelle; El Emam, Khaled
Background: Personal digital assistants (PDAs) find many uses in health care. Knowing rates of collective PDA use among health care providers is an important guiding step to further understanding those health care contexts that are most suited to PDA use and whether PDAs provide improved health outcomes. Objectives: The objectives of this study were to estimate current and future PDA use among health care providers and to discuss possible implications of that use on choice of technology in clinical practice and research. Methods: This study was a systematic review of PDA usage surveys. Surveys were identified as part of an ongoing systematic review on the use of handheld devices. Reports from eight databases covering both biomedical sciences and engineering (1993-2006) were screened against distinct eligibility criteria. Data from included surveys were extracted and verified in a standardized way and were assessed descriptively. Results: We identified 23 relevant surveys, 15 of which were derived from peer-reviewed journals. This cohort of surveys was published between 2000 and 2005. Overall, since 1999, there is clear evidence of an increasing trend in PDA use. The current overall adoption rate for individual professional use ranges between 45% and 85%, indicating high but somewhat variable adoption, primarily among physicians. Conclusions: Younger physicians and residents and those working in large and hospital-based practices are more likely to use a PDA. The adoption rate is now at its highest rate of increase according to a commonly accepted diffusion of innovations model. A common problem with the evaluation of information technology is that use frequently precedes research. This is the case here, in which PDA adoption rates are already high and projections are for rapid growth in the short term. In general, it appears that professional PDA use in health care settings involves more administrative and organizational tasks than those related to patient care, perhaps signaling where the growth in adoption is most likely to occur. We conclude that physicians are likely accustomed to using a PDA, and, therefore, technology expertise will probably not be a barrier to implementing PDA applications. However, there is an urgent need to evaluate the effectiveness and efficiency of specific tasks using handheld technology to inform those developing and those using PDA applications.
Evaluating common de-identification heuristics for personal health information
(2006) El Emam, Khaled; Jabbouri, Sam; Sams, Scott; Drouet, Youenn; Power, Michael
Background: With the growing adoption of electronic medical records, there are increasing demands for the use of this electronic clinical data in observational research. A frequent ethics board requirement for such secondary use of personal health information in observational research is that the data be de-identified. De-identification heuristics are provided in the Health Insurance Portability and Accountability Act Privacy Rule, funding agency and professional association privacy guidelines, and common practice. Objective: The aim of the study was to evaluate whether the re-identification risks due to record linkage are sufficiently low when following common de-identification heuristics and whether the risk is stable across sample sizes and data sets. Methods: Two methods were followed to construct identification data sets. Re-identification attacks were simulated on these. For each data set we varied the sample size down to 30 individuals, and for each sample size evaluated the risk of re-identification for all combinations of quasi-identifiers. The combinations of quasi-identifiers that were low risk more than 50% of the time were considered stable. Results: The identification data sets we were able to construct were the list of all physicians and the list of all lawyers registered in Ontario, using 1% sampling fractions. The quasi-identifiers of region, gender, and year of birth were found to be low risk more than 50% of the time across both data sets. The combination of gender and region was also found to be low risk more than 50% of the time. We were not able to create an identification data set for the whole population. Conclusions: Existing Canadian federal and provincial privacy laws help explain why it is difficult to create an identification data set for the whole population. That such examples of high re-identification risk exist for mainstream professions makes a strong case for not disclosing the high-risk variables and their combinations identified here. For professional subpopulations with published membership lists, many variables often needed by researchers would have to be excluded or generalized to ensure consistently low re-identification risk. Data custodians and researchers need to consider other statistical disclosure techniques for protecting privacy.
A survey of quality assurance practices in biomedical open source software projects
(2007) Koru, Günes; El Emam, Khaled; Neisa, Angelica; Umarji, Medha
Background: Open source (OS) software is continuously gaining recognition and use in the biomedical domain, for example, in health informatics and bioinformatics. Objectives: Given the mission critical nature of applications in this domain and their potential impact on patient safety, it is important to understand to what degree and how effectively biomedical OS developers perform standard quality assurance (QA) activities such as peer reviews and testing. This would allow the users of biomedical OS software to better understand the quality risks, if any, and the developers to identify process improvement opportunities to produce higher quality software. Methods: A survey of developers working on biomedical OS projects was conducted to examine the QA activities that are performed. We took a descriptive approach to summarize the implementation of QA activities and then examined some of the factors that may be related to the implementation of such practices. Results: Our descriptive results show that 63% (95% CI, 54-72) of projects did not include peer reviews in their development process, while 82% (95% CI, 75-89) did include testing. Approximately 74% (95% CI, 67-81) of developers did not have a background in computing, 80% (95% CI, 74-87) were paid for their contributions to the project, and 52% (95% CI, 43-60) had PhDs. A multivariate logistic regression model to predict the implementation of peer reviews was not significant (likelihood ratio test = 16.86, 9 df, P = .051) and neither was a model to predict the implementation of testing (likelihood ratio test = 3.34, 9 df, P = .95). Conclusions: Less attention is paid to peer review than testing. However, the former is a complementary, and necessary, QA practice rather than an alternative. Therefore, one can argue that there are quality risks, at least at this point in time, in transitioning biomedical OS software into any critical settings that may have operational, financial, or safety implications. Developers of biomedical OS applications should invest more effort in implementing systemic peer review practices throughout the development and maintenance processes.

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