Biography:

Xiaoli Pang obtained her B.M Diploma in Dec 1982 from the Faculty of Medicine, South-East University, Nanjing, China and completed her PhD in 2000 from the University of Tampere, Finland. She is a Professor in the Department of Laboratory Medicine and Pathology University of Alberta, and a Principal Investigator in Li Ka Shing Institute of Virology, and a Program Leader in Provincial Lab for Public Health, Alberta, Canada. She has held numerous research grants and published approximately 90 peer review papers and book charters.

Abstract:

Acute gastroenteritis (AGE) is a very common childhood condition. Current pathogen-specifi c disease burden may be inaccurate due to bias introduced by diffi culties in obtaining stool samples, the low sensitivity of classic diagnostic assays and the inability of laboratories to conduct testing in vomiting-only cases. Th e Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) conducted a prospective study to detect enteropathogens causing diarrhea and/or vomiting in Albertan children using enhanced specimen collection and advanced diagnostic assays. Children under 18 years of age with AGE were recruited through two pediatric Emergency Departments (ED) and a telephone Health Advice Service (HLA). Rectal swabs and stool samples were collected and tested for 5 viruses, 9 bacteria and 3 parasites using enteric bacteria culture assays, an in-house RT-qPCR gastroenteritis virus panel and the Luminex xTAG GPP. 2,427 children with AGE were enrolled in the EDs and 647 were enrolled via HLA from Dec 2014 to Jan 2018. 72.9% (n=2,199) of the 3,018 symptomatic patients tested positive for ≥ 1 enteropathogen. Norovirus was the most commonly detected pathogen (n=807, 26.7%), followed by adenovirus (n=563, 18.7%) and rotavirus (n=507, 16.8%). Sapovirus (n=297, 9.8%) and astrovirus (n=106, 3.5%) were less prevalent. Clostridium diffi cile was detected in 14.4% (n=436) of AGE cases. Excluding C. diffi cile, other enteric bacteria and parasites were detected in 5.9% (n=176) and 16 (0.5%) patients, respectively. Th is study provides a better understanding of the relative proportion of enteropathogens in children with AGE.

Biography:

Ajay Desai DCH, DNB(Paed), MRCPCH, FRCPCH is a consultant in paediatric intensive care medicine at Royal Brompton Hospital in London, United Kingdom. He is the lead for the paediatric Extracorporeal Membrane Oxygenation (ECMO) programme, with a special interest in Extracorporeal Cardiopulmonary Resuscitation (ECPR). He has completed his postgraduate paediatric training in Mumbai, India. He gained further experience in paediatric intensive care and paediatric cardiology in London tertiary centres prior to his appointment as a consultant in 2010. And he is the RCPCH College Tutor, and Co-Chair for Science and Education Committee in Paediatric Intensive Care Society UK. He is also a faculty member for the International Pediatric Simulation Society (IPSS) – Education Subgroup. And research interests are ECPR – factors affecting morbidity and mortality. Impact of Down’s syndrome status on early intensive care outcomes in children following Complete Atrioventricular Septal Defect (CAVSD) repair

Abstract:

Background and Aims: Blood and blood products are an expensive and precious resource. Liberal use of blood and blood product use in ECMO patients does not improve survival rates. We hypothesised that increased sampling leads to unnecessary use of blood products in ecmo patients. We audited local clinical practice changes in blood sampling and blood-product transfusions aft er introduction of ECMO pathway and update of anti-coagulation guidelines.

Methods: We compared frequency of blood sampling and use of blood/blood products pre-Jan 2016 (Group 1, n=13) and post Jan 2016 (Group 2, n=13). Key changes introduced in Jan 2016 included a. Reduction in blood sampling frequency - 4-6 hourly to 2/day; b. No routine blood cultures during ECMO; c. ACT monitoring 1hrly to 2-4hrly when stable; d. no routine antithrombin III measurements. Th reshold for blood transfusion remained as per PICU protocol. Additional sampling only if clinically indicated. We evaluated the number of donor exposures in each group and measured cost efficiency.

Results: Th ere was signifi cant reduction in the number of blood samples in group 1. Th ere was signifi cant reduction in the use of blood/ blood products in group 2. Patients in Group 1 were exposed to signifi cantly increased number of donors. Cost implications were signifi cantly higher in Group 1 compared to Group 2. 3/11(28%) in Group 1 and 9/13(69%) in Group 2 survived PICU discharge. However, this audit was not aimed at evaluating factors for mortality in ECMO patients.

Conclusion: It is feasible to rationalise and reduce the use of blood and blood products and achieve good survival outcomes in paediatric ECMO patients.

References: 1. Murphy DA et al. Extracorporeal Membrane Oxygenation - Haemostatic complications, Tranfus Med Rev (2015). 2. Chalwin RP, Tiruvoipati R, Peek GJ. Fatal Th rombosis with activated factor VII in a paediatric patient on extracorporeal membrane oxygenation. Eur J cardiothoracic Surg 2008;34: 685-6.

Biography:

Nikole Gase is working as a Research Scholar from University of Texas Medical Branch. Her research experience includes various programs, contributions and participation in different countries for diverse fi elds of study. Her research interests as a Research Scholar refl ect in his/her wide range of publications in various national and international journals.

Abstract:

Background: Hypothermia is a major cause of neonatal mortality, accounting for 18-42% of annual global neonatal death. Th is can be linked to higher body surface area to body mass ratio of infants causing decreased ability to insulate body heat. Conventional methods to prevent neonatal hypothermia in the hospital includes blanket bundling. The purpose of this analysis was to evaluate the eff ectiveness of plastic wraps compared to standard blankets in preventing neonatal hypothermia aft er birth. 

Methods: Th e PubMed, Ovid (Medline), and Research Gate databases were used to begin research into the clinical question. Online fi lters set when searching articles included; full text available, English language, and infant/newborn subjects. Terms used in search included “Body temperature”, “Infant”, “Delivery”, “Neonatal”, “Th ermoregulation”, “Hypothermia”, and/or “Polyethylene”. Research articles with titles pertinent to the clinical question were initially collected, reviewed in detail, and then selectively omitted if inapplicable to the research question. Studies omitted include; meta-analysis designs, systematic review designs, or studies whose comparison did not match the clinical question (i.e. comparing neonates with plastic wrap technique vs neonates without any warming technique or comparing two diff erent plastic materials). Seventeen articles were initially selected based on search criteria, and ten were ultimately chosen based on relevant content.

Results: A meta-analysis using Biostat 2.0 soft ware was conducted on 9 of the 10 reviewed studies using intervention and control mean and P values. Th e article by Smith, J. 2013 was excluded due to a lack of available study metrics required for analysis. Th e results of the meta-analysis revealed a mean body temperature of +0.533 C in the plastic wrap intervention group, with a 95% CI 0.410-0.657; P=<.001. All included studies showed subjects’ body temperature remained higher when cared for using plastic wraps and, when assessed, required less aggressive radiant and thermal warming. Additional metrics observed within the reviewed studies showed subjects who were wrapped in plastic had a higher NICU admission temperatures, required less aggressive resuscitative eff orts, and had lower mortality rates.

Conclusion: Although conventional methods to prevent neonatal hypothermia focus on blanket bundling, the results of this meta-analysis reveal adequate evidence showing the superiority of plastic wrap intervention in increasing and/or maintaining higher body temperatures in neonates. By maintaining these higher body temperatures, this suggests plastic wraps play a key role in also reducing the rates of neonatal hypothermia. In addition, because the onset of hypothermia is a major cause of neonatal mortality, one should also expect mortality rates to decline. Incorporating the use of plastic wraps into thermoregulation guidelines across health care facilities should be considered as part of standard of care. However, further research may need to be conducted to determine a precise protocol that would provide the most overall benefi t.

Biography:

Faisal Ashour has completed his bachelor’s degree in Modeling, Simulation, and Visualization Engineering in 2015 from Old Dominion University, USA along with an associate degree in Electrical Engineering and Engineering Management. He gained his fellowship in Medical Simulation from INCASL in 2016. He joined the Ministry of National Guard Health Affairs-King Saud bin Abdulaziz University for Health Sciences-Jeddah in 2015 as a military and medical simulation engineer. The Personal Investigator for this research is Dr. Suliman Al-Ghamdi, MD, FRCPC. He is a Radiation Oncologist, and the head of Radiation Oncology at Princess Noorah Oncology Center. Dr. Suliman is also the deputy chairman of Princess Noorah Oncology Center and head of King Abdullah International Medical Research Center Jeddah (KAIMRC-J)

Abstract:

VR is a three-dimensional (3D) computer-generated environment that enables the user to explore and interact within a diff erent environmental perspective. It could be in the form of a realistic-artifi cial environment or a 3D imaging that is presented to the user as a real atmosphere with made-up information. Th e VR has-been considered as a non-pharmacologic form of analgesia through exerting attention processes on the body’s intricate pain system. It does so through profoundly immersing the body and mind by delivering enough sensory information to the extent where it suspense any disbelief that one is in a virtual environment. Th e aim of the study is to eliminate the General Anaesthesia (GA) procedure used on paediatric oncology patients undergoing multiple fractions of Radiotherapy. We aimed to utilise the VR technology as a replacement for the GA. Typically, the radiotherapy session under GA takes around 30 minutes from the machine time and that session can be repeated daily for several weeks. As a result, VR Technology was an excellent alternative in most of the patients treated with radiotherapy for non-Head/Brain Tumours. Th ere were signifi cant reductions on the number of the GA sessions. Th at reductions have a great impact on reducing side eff ect of GA and save more time on the Radiotherapy machine that can be used to treat more patients.

Biography:

Jill Blitz has been a Physical Therapist for 17 years, with the last 15 providing service at Children’s Hospital Los Angeles Division of Pediatric Medicine outpatient and rheumatology clinics. Her research has focused on exercise in adolescents with rheumatologic involvement, which has led her to speak at multiple national and community conferences, including the American College of Rheumatology Scientifi c Meeting and the APTA Combined Sections Meeting. She has also taught a continuing education course on physical therapy for children with rheumatic diagnoses. One of her many goals include fi nding ways to get kids of all abilities to be more active.

Abstract:

To evaluate the impact of pedometer use on the Physical Activity (PA) and Functional Walking Capacity (FWC) of adolescents with Juvenile Idiopathic Arthritis (JIA) and Lower Extremity (LE) involvement. Twenty-seven adolescents, ages 11-19 years with JIA and LE involvement participated in the 3-phase pedometer study that introduced the use of a pedometer and an education seminar at 6 weeks. Measurements were taken at the baseline fi rst visit and at weeks 6, 12 and 20. Th e primary outcome measure was the 6-minute walk test (6MWT). Th irteen completed the study. Six-minute walk distance (6MWD) signifi cantly increased from baseline (458.0±70.8 m) to the end of phase 1(501.4 ±59.8 m) (p = 0.035), prior to receiving the pedometer; and from baseline to the end of study (p=0.0037). No signifi cant changes in 6MWD were found between weeks 6 and 12 (intervention) (p=0.77) or between weeks 12 and 20 (follow through phase)(p=0.27). In adolescents with LE JIA, consistent guidance and support by rheumatology professionals appears to positively infl uence PA and measures of FWC as seen through improved 6MWD. Th ere was insuffi cient evidence to show that pedometers further increased FWC or PA.

Biography:

Sonam Chophel is currently working in NICU as a staff nurse at JDWNRH, Thimphu. After completing diploma in General nursing and midwifery from Faculty of Nursing and Public Health under Khesar Gyalpo University of Medical Sciences, Bhutan. As a focal person of Quality Improvement project of the unit is responsible for upcoming QI project on Post natal Care of newborn mother.

Abstract:

Introduction: Th ere are fi ft y key performance indicators in APA of JDWNRH to measure success of the organizational. Th e indicator 41, discharge of the patients before 11 am is one of them.

Objective: To increase the percentage of ‘before 11 am discharge’ from base line data of 38 % in (NICU) and 20% in (Neonate) to 50% in four months following interventions in in NICU and Neonate ward, JDWNRH

Method: Th e study was set in a 16-bedded NICU and 24-bedded Neonatal ward of National Referral Hospital in Bhutan. A Multidisciplinary Quality Improvement Team was formed. Baseline assessment included review of the daily activities and causes of delayed discharge were documented using root cause analysis. Th e data were collected daily and reviewed weekly. Th e interventions were developed based on the base line assessment and were implemented consistently. Th e change was monitored and reviewed periodically using the Plan Do Study Act (PDSA) method.

Result: Th e interventions included multiple system changes such as daily activity fl ow chart, new discharge checklist, screening checklist, high risk assessment checklist and due laboratory report fi le. Th e baseline percentage of patients discharged before 11 am before introduction of the interventions was 38.46% in NICU and 20% in Neonatal ward which drastically increased to 84.1% and 65.4% respectively following four months implementation of the interventions. Towards the end of 11th months, the percentage reached to 100% in NICU and 89% in neonate ward. In addition, it has improved teamwork, work effi ciency and brought in numbers of positive changes in the units.

Conclusion: A multidisciplinary team with quality improvement project improved this performance indicator and effi ciency of work but also teamwork.

Biography:

Sari has completed her education as general surgeon from Universitas Indonesia in 2018. Tri hening is pediatric surgeon in Ciptomangunkusumo Hospital and she is undergoing doctoral program in Universitas Indonesia. Sastiono is pediatric surgeon and senior staff in pediatric division Department Surgery Faculty of Medicine Universitas Indonesia.

Abstract:

Background & Objective: Budd-Chiari syndrome (BCS) in children is a rare case. Th e prevalence of SBC in India is reported to be 7.4%. No publication on the prevalence of SBC in RSCM. Because of that, there is diffi culty in diagnosing and choosing the best management of these patients, especially in BCS with moderate fi brosis.

Method: Conducted literature research on various sites, such as Clinical Key, PubMed, ScienceDirect, and EBSCOhost, by asking the research question "How is the scientifi c evidence supporting liver transplantation in Budd-Chiari Syndrome with moderate fi brosis in children?". Th e literature criteria are systematic review, randomized-clinical trial, cohort study, case report, or case series. Published studies should be performed on humans, whether living donor or cadaveric transplantation, English or Indonesian language, no publication year limit, and available in full-text form. BCS in adult or publication in the form of correspondence, editorial, or commentary excluded. Critical review was carried out using instruments downloaded from equator-network.org, then interpreted, and made a conclusion.

Result: One case series that reports BCS in children with moderate fi brosis. Liver transplantation is a treatment option for moderate fi brosis with level of evidence 4. Reversibility of tissue damage, etiology, and patient readiness are other factors to consider before deciding on liver transplantation.

Conclusion: Liver transplantation in BCS in children with moderate fi brosis is being supported by case series study with level of evidence 4. Th e need to consider other factors, including general condition of patient, duration of symptoms, and location of blockage.