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Addressing barriers to evidence- based medicine in pediatric surgery: an introduction to the Canadian Association of Paediatric Surgeons Evidence- Based Resource

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World Journal of Pediatric Surgery 2022年第1期5卷 25-29页

作者： viviane grandpierre Irina Oltean Manvinder Kaur Ahmed Nasr Department of Surgery Children's Hospital of Eastern OntarioOttawaOntarioCanada University of Ottawa OttawaOntarioCanada

Background Pediatric surgical practice lags behind medicine in presence and use of evidence,primarily due to time constraints of using existing tools that are not specific to pediatric surgery,lack of sufficient patient data and unstructured pediatric surgery training *** We developed,disseminated and tested the effectiveness of an evidence-based resource for pediatric surgeons and researchers that provides brief,informative summaries of quality-assessed systematic reviews and meta-analyses on conflicting pediatric surgery *** Responses of 91 actively practicing surgeons who used the resource were *** majority of participants found the resource useful(75%),improved their patient care(66.6%),and more than half(54.2%)found it useful in identifying research *** all participants reported that the resource could be used as a teaching tool(93%).Conclusion Lack of awareness of the resource is the primary barrier to its routine use,leading to potential calls for more active dissemination *** of the Canadian Association of Paediatric Surgeons Evidence-Based Resource find that the summaries are useful,identify research gaps,help mitigate multiple barriers to evidence-based medicine,and may improve patient care.

关键词： pediatric surgery routine

Predictors of spontaneous resolution of umbilical hernia in children

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World Journal of Pediatric Surgery 2021年第3期4卷 35-38页

作者： Manvinder Kaur viviane grandpierre Irina Oltean Arielle Weir Ahmed Nasr Department of Surgery Children's Hospital of Eastern OntarioOttawaCanada

Objective The aims were to describe the management of umbilical hernias,to define postoperative complications,and to identify the characteristics of patients that were more likely to have spontaneous resolution of their *** All patients referred for umbilical hernia at the Children’s Hospital of Eastern Ontario from January 1990 to April 2017 were examined via retrospective chart *** resolution of umbilical hernia was examined using binary logistic *** We included 2621 patients presenting with an umbilical hernia.A total of 1587(60.5%)patients underwent surgical repair at a median age of 3.6 years(IQR 2.3-5.4).Surgical complications consisted of infection(n=3),bleeding(n=3),hematoma(n=3),and anesthesia-related complications(n=3).For every one-unit increase in defect size,the odds of a spontaneous resolution of the hernia were 5%lower while controlling for prematurity and the presence of comorbidities[adjusted odds ratio(aOR)=0.95;95%confidence intervel(CI)0.93 to 0.97].Premature babies were 80%less likely to experience hernia resolution compared with non-premature babies(aOR=0.20;95%CI 0.03 to 0.74).Conclusion The odds of spontaneous resolution were lower for premature babies and were negatively correlated with defect size.

关键词： hernia anesthesia resolution

Postoperative complications of colectomy and J- pouch with ileostomy versus without ileostomy in children with inflammatory bowel diseases: a systematic review and meta- analysis

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World Journal of Pediatric Surgery 2022年第2期5卷 38-45页

作者： Irina Oltean Nicole Travis Manvinder Kaur viviane grandpierre Lamia Hayawi Anne Tsampalieros Ahmed Nasr Department of Surgery Children's Hospital of Eastern OntarioOttawaOntarioCanada Children's Hospital of Eastern Ontario Research Institute Clinical Research UnitOttawaOntarioCanada University of Ottawa OttawaOntarioCanada

Background The efficacy of performing a restorative proctocolectomy and J-pouch ileoanal anastomosis without diverting ileostomy in children with inflammatory bowel disease has been a longstanding debate.A systematic review and meta-analysis is presented comparing the occurrence of postoperative complications in children who underwent either the pouch-anal anastomosis(IPAA)with ileostomy(diverted)versus the undiverted *** Records were sourced from CINAHL,CENTRAL,EMBASE and MEDLINE *** followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and compared postoperative complications in pediatric patients diagnosed with inflammatory diseases aged less than 18 years who underwent J-pouch with ileostomy versus without *** primary outcome was the occurrence of postoperative leaks,and the secondary outcomes were presence of postoperative small bowel obstruction(SBO),pouchitis,stricture and fistula complications.A random-effects meta-analysis was *** Twenty-three observational studies in the systematic review were included with 658 patients(83%diverted,17%undiverted).Pooled estimates showed no difference in occurrence of leaks in children who underwent J-pouch/IPAA with ileostomy versus without(odds ratio(OR)0.54,95%confidence interval(CI)0.17 to 1.64,I^(2)=16%).There was no difference in the occurrence of SBO,pouchitis or strictures in children who underwent J-pouch/IPAA with ileostomy versus without(SBO:OR 2.27,95%CI 0.52 to 9.92,I^(2)=0%,pouchitis:OR 1.76,95%CI 0.95 to 3.24,I^(2)=0%,strictures:OR 2.72,95%CI 0.44 to 16.69,I^(2)=66%).Conclusion The meta-analysis did not find differences in the occurrence of complications in pediatric patients who underwent the IPAA with ileostomy procedure versus without ileostomy.

关键词： complications bowel diseases

Quality of life outcomes in children after surgery for Hirschsprung disease and anorectal malformations:a systematic review and meta-analysis

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World Journal of Pediatric Surgery 2022年第4期5卷 204-210页

作者： Irina Oltean Lamia Hayawi Victoria Larocca Vid Bijelić Emily Beveridge Manvinder Kaur viviane grandpierre Jane Kanyinda Ahmed Nasr Department of Surgery Children's Hospital of Eastern OntarioOttawaOntarioCanada Clinical Research Unit Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada

Background No systematic review and meta-analysis to date has examined multiple child and parent-reported social and physical quality of life(QoL)in pediatric populations affected by Hirschsprung’s disease(HD)and anorectal malformations(ARM).The objective of this systematic review is to quantitatively summarize the parent-reported and child-reported psychosocial and physical functioning scores of such *** Records were sourced from the CENTRAL,EMBASE,and MEDLINE *** that reported child and parent reported QoL in children with HD and ARM,regardless of surgery intervention,versus children without HD and ARM,were *** primary outcome was the psychosocial functioning scores,and the secondary outcomes were the presence of postoperative constipation,postoperative obstruction symptoms,fecal incontinence,and enterocolitis.A random effects meta-analysis was *** Twenty-three studies were included in the systematic review,with 11 studies included in the ***,1678 total pediatric patients with HD and ARM underwent surgery vs 392 healthy *** parent-reported standardized mean(SM)scores showed better social functioning after surgery(SM 91.79,95%CI(80.3 to 103.3),I2=0).The pooled standardized mean difference(SMD)showed evidence for parent-reported incontinence but not for constipation in children with HD and ARM after surgery that had a lower mean QoL score compared with the normal population(SMD−1.24(-1.79 to–0.69),I2=76%and SMD−0.45,95%CI(−1.12 to 0.21),I2=75%).The pooled prevalence of child-reported constipation was 22%(95%CI(16%to 28%),I2=0%).The pooled prevalence of parent-reported postoperative obstruction symptoms was 61%(95%CI(41%to 81%),I2=41%).Conclusion The results demonstrate better social functioning after surgery,lower QoL scores for incontinence versus controls,and remaining constipation and postoperative obstruction symptoms after surgery in children with HD and ARM.

关键词： surgery Hirschsprung analysis

Needs assessment of parents for a patient decision aid in pediatric interval appendectomy via the qualitative interview method

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World Journal of Pediatric Surgery 2022年第2期5卷 16-22页

作者： viviane grandpierre Katherine Duba Karine Toupin April Irina Oltean Arielle Weir Ahmed Nasr Surgery Children's Hospital of Eastern OntarioOttawaOntarioCanada Biology Clarkson UniversityPotsdamNew YorkUSA Pediatrics University of OttawaOttawaOntarioCanada

Objectives Appendicitis is one of the most commonly encountered pediatric surgical diagnoses,with non-operative management of perforated appendicitis leading to two treatment options:an interval appendectomy(IA)or expectant *** primary objective of this study was to assess parents’need for a patient decision aid(PDA)among parents considering IA or expectant management.A secondary objective was to determine parent preferences for the format and distribution plan of a drafted patient decision *** Coulter’s systematic development process for PDA was used to guide the assessment interviews for *** included caregivers of a patient who experienced perforated appendicitis,and admission between 2019 and ***-structured individual interviews were conducted to collect information about decision-making needs of parents of children who experienced perforated *** A total of 12 different parents participated in the *** indicate decisional conflict associated with the lack of evidence for optimal treatment,supporting the need for the development of a patient decision aid to assist in clarifying information and parent values with *** clearly identified a need for evidence to support decision-making in various formats(eg,pamphlet or electronic).Timing of when to deliver the PDA varied(ie,during hospital admission,at discharge,or at follow-up appointment).Conclusion Results indicated various factors contributing to parental decisional conflict,including the lack of evidence showing the optimal treatment,the need for more information,and guidance from ***,findings indicate a strong need for a patient decision aid.

关键词： qualitative interview supporting