Publications by authors named "Esli Osmanlliu"

7 Publications

  • Page 1 of 1

Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments: A Nationwide Study.

Pediatr Emerg Care 2021 Jun 1. Epub 2021 Jun 1.

From the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology Biostatistical Design and Analysis team, The Hospital for Sick Children, University of Toronto, Toronto Department of Pediatrics and Emergency Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Ontario Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University, Montreal, Quebec Department of Pediatrics, Division of Emergency Medicine, McMaster Children's Hospital, Hamilton, Ontario Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta Division of Pediatric Emergency Medicine, British Columbia Children's Hospital, Vancouver, British Columbia Department of Pediatrics and Emergency Medicine, University of Manitoba, Winnipeg, Manitoba Department of Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia Division of Pediatric Emergency Medicine, Department of Pediatrics, Schulich School of Medicine, Western University, London, Ontario Division Pediatric Emergency Medicine, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Objectives: The aim of this study was to quantify the effect of the COVID-19 pandemic on pediatric emergency department (ED) utilization and outcomes.

Methods: This study is an interrupted-time-series observational study of children presenting to 11 Canadian tertiary-care pediatric EDs. Data were grouped into weeks in 3 study periods: prepandemic (January 1, 2018-January 27, 2020), peripandemic (January 28, 2020-March 10, 2020), and early pandemic (March 11, 2020-April 30, 2020). These periods were compared with the same time intervals in the 2 preceding calendar years. Primary outcomes were number of ED visits per week. The secondary outcomes were triage acuity, hospitalization, intensive care unit (ICU) admission, mortality, length of hospital stay, ED revisits, and visits for trauma and mental health concerns.

Results: There were 577,807 ED visits (median age, 4.5 years; 52.9% male). Relative to the prepandemic period, there was a reduction [-58%; 95% confidence interval (CI), -63% to -51%] in the number of ED visits during the early-pandemic period, with concomitant higher acuity. There was a concurrent increase in the proportion of ward [odds ratio (OR), 1.39; 95% CI, 1.32-1.45] and intensive care unit (OR, 1.20; 95% CI, 1.01-1.42) admissions, and trauma-related ED visits among children less than 10 years (OR, 1.51; 95% CI, 1.45-1.56). Mental health-related visits in children declined in the early-pandemic period (in <10 years, -60%; 95% CI, -67% to -51%; in children ≥10 years: -56%; 95% CI, -63% to -47%) relative to the pre-COVID-19 period. There were no differences in mortality or length of stay; however, ED revisits within 72 hours were reduced during the early-pandemic period (percent change: -55%; 95% CI, -61% to -49%; P < 0.001).

Conclusions: After the declaration of the COVID-19 pandemic, dramatic reductions in pediatric ED visits occurred across Canada. Children seeking ED care were sicker, and there was an increase in trauma-related visits among children more than 10 years of age, whereas mental health visits declined during the early-pandemic period. When faced with a future pandemic, public health officials must consider the impact of the illness and the measures implemented on children's health and acute care needs.
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June 2021

Parental administration of inhaled short-acting beta agonists in the pediatric emergency department: a survey of family perspectives.

CJEM 2021 Jun 1. Epub 2021 Jun 1.

Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de La Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.

Background: The management of children with an asthma exacerbation includes timely systemic corticosteroids and frequent short-acting beta-agonist therapy. In selected patients, inhaled short-acting beta-agonist administration by parents may promote comfort, constitute an educational opportunity for the family, and safely reduce provider workload. Our objective was to evaluate parental satisfaction and perceived safety of this new approach.

Method: This was a cross-sectional study, conducted in a tertiary pediatric ED. We investigated patient and parent perspectives on a newly implemented parental short-acting beta-agonist administration program. A convenience sample of families participating in this program was approached for study enrolment. The primary outcome was the proportion of parents and children who were satisfied with the program. We also evaluated the program's safety and impact on asthma education as reported by parents.

Results: From February 2019 to March 2020, 72 of 74 (97%) families approached for enrolment participated in the survey. A vast majority (95%) of parents appreciated the program and 93% would participate again. Among children > 7 years, 86% preferred receiving inhaled short-acting beta-agonist by their parents rather than by a healthcare provider. Nearly all parents (96%) found the program to be "safe" or "very safe". Some participants reported improvements in their inhaler administration technique (25%) and ability to recognize their child's respiratory distress (25%).

Conclusion: A novel parental short-acting beta-agonist administration program in the pediatric ED was widely appreciated by participating families. Parents perceived it as being safe, educational, and contributing to their child's comfort.
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June 2021

Considerations for the Design and Implementation of COVID-19 Contact Tracing Apps: Scoping Review.

JMIR Mhealth Uhealth 2021 06 9;9(6):e27102. Epub 2021 Jun 9.

Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada.

Background: Given the magnitude and speed of SARS-CoV-2 transmission, achieving timely and effective manual contact tracing has been a challenging task. Early in the pandemic, contact tracing apps generated substantial enthusiasm due to their potential for automating tracing and reducing transmission rates while enabling targeted confinement strategies. However, although surveys demonstrate public interest in using such apps, their actual uptake remains limited. Their social acceptability is challenged by issues around privacy, fairness, and effectiveness, among other concerns.

Objective: This study aims to examine the extent to which design and implementation considerations for contact tracing apps are detailed in the available literature, focusing on aspects related to participatory and responsible eHealth innovation, and synthesize recommendations that support the development of successful COVID-19 contact tracing apps and related eHealth technologies.

Methods: Searches were performed on five databases, and articles were selected based on eligibility criteria. Papers pertaining to the design, implementation, or acceptability of contact tracing apps were included. Articles published since 2019, written in English or French, and for which the full articles were available were considered eligible for analysis. To assess the scope of the knowledge found in the current literature, we used three complementary frameworks: (1) the Holistic Framework to Improve the Uptake and Impact of eHealth Technologies, (2) the Montreal model, and (3) the Responsible Innovation in Health Assessment Tool.

Results: A total of 63 articles qualified for the final analysis. Less than half of the selected articles cited the need for a participatory process (n=25, 40%), which nonetheless was the most frequently referenced item of the Framework to Improve the Uptake and Impact of eHealth Technologies. Regarding the Montreal model, stakeholder consultation was the most frequently described level of engagement in the development of contact tracing apps (n=24, 38%), while collaboration and partnership were cited the least (n=2, 3%). As for the Responsible Innovation in Health framework, all the articles (n=63, 100%) addressed population health, whereas only 2% (n=1) covered environmental considerations.

Conclusions: Most studies lacked fundamental aspects of eHealth development and implementation. Our results demonstrate that stakeholders of COVID-19 contact tracing apps lack important information to be able to critically appraise this eHealth innovation. This may have contributed to the modest uptake of contact tracing apps worldwide. We make evidence-informed recommendations regarding data management, communication, stakeholder engagement, user experience, and implementation strategies for the successful and responsible development of contact tracing apps.
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June 2021

Decontamination effectiveness and the necessity of innovation in a large-scale disaster simulation.

Am J Disaster Med 2021 Winter;16(1):67-73

Associate Professor, Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, Canada.

Background: Chemical, biological, radiologic, nuclear, and explosive (CBRNE) events threaten the health and integrity of human populations across the globe. Effective decontamination is a central component of CBRNE disaster response.

Objective: This paper provides an objective determination of wet decontamination effectiveness through the use of a liquid-based contaminant proxy and describes the mobilization and adaptation of easily available materials for the needs of decontamination in pediatric victims.

Methods: In this in-situ disaster simulation conducted at a pediatric hospital, decontamination effectiveness was determined through a liquid-based contaminant proxy, and standard burn charts to systematically estimate affected total body surface area (TBSA) in 39 adult simulated patients. Two independent raters evaluated TBSA covered by the contaminant before and after decontamination.

Results: On average, simulated patients had 59 percent (95 percent CI [53, 65]) of their TBSA covered by the simulated contaminant prior to decontamination. Following a wet decontamination protocol, the average reduction in TBSA contamination was 81 percent (95 percent CI [74, 88]). There was high inter-rater reliability for TBSA assessment (intraclass correlation coefficient = 0.83, 95 percent CI [0.68, 0.92]. A modified infant bath was tested during the simulated decontamination of infant mannequins and thereafter integrated to the local protocol.

Conclusion: Wet decontamination can remove more than 80 percent of the initial contaminant found on adult simulated patients. The use of a liquid-based visual tool as a contaminant proxy enables the inexpensive evaluation of decontamination performance in a simulated setting. This paper also describes an innovative, low-cost adaptation of a local decontamination protocol to better meet pediatric needs.
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May 2021

Distraction in the Emergency department using Virtual reality for INtravenous procedures in Children to Improve comfort (DEVINCI): a pilot pragmatic randomized controlled trial.

CJEM 2021 Jan 23;23(1):94-102. Epub 2020 Dec 23.

CHU Sainte-Justine Research Centre, Université de Montréal, Montréal, Canada.

Objectives: Intravenous (IV) procedures cause pain and distress in the pediatric emergency department (ED). We studied the feasibility and acceptability of virtual reality distraction for patient comfort during intravenous procedures.

Methods: Children were randomized to a control (standard care) or intervention group (standard care + virtual reality). Thresholds for feasibility and acceptability (primary outcomes) were determined through a priori established criteria. The level of procedural pain (principal clinical outcome) and distress, as well as memory of pain at 24 h were collected and reported as medians (Q1, Q3) for each group.

Results: 63 patients were enrolled, with a high rate of recruitment (78.8%) and game completion (90.3%). Patients, parents and, healthcare providers reported high satisfaction levels. There were no serious adverse events. Five of the 30 patients (16.7%) exposed to virtual reality reported mild side effects. Self-reported procedural pain (verbal numerical rating scale: 3 (1, 6)/10 vs 3 (1, 5.5)/10, p = 0.75) was similar between groups. Further exploratory clinical measures were reported for the intervention and control groups, respectively: self-rated distress during the procedure (Child Fear Scale: 1 (0, 2)/4 vs 2 (0, 3)/4); distress evaluated by proxy during the procedure (Procedure Behavior Check List: 8 (8, 9)/40 vs 10 (8, 15)/40); memory of pain at 24 h (VNRS: 2 (1, 3)/10 vs 4 (2, 6.5)/10).

Conclusion: The addition of virtual reality to standard care is feasible and acceptable for pain and distress management during IV procedures in the pediatric ED. Occasional mild, self-resolving side effects were observed in the intervention group. Self-reported pain during the procedure was similar between groups. CLINICALTRIALS.

Gov Identifier: NCT03750578.
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January 2021

Frequent users of the pediatric emergency department.

CJEM 2018 05 6;20(3):401-408. Epub 2017 Apr 6.

†Division of Pediatric Neurology,Department of Pediatrics,Montreal Children's Hospital,McGill University Health Centre,Montreal,QC.

Objectives: Emergency department (ED) crowding is associated with increased morbidity and mortality. Its etiology is multifactorial, and frequent ED use (defined as more or equal to five visits per year) is a major contributor to high patient volumes. Our primary objective is to characterize the frequent user population. Our secondary objective is to examine risk factors for frequent emergency use.

Methods: We conducted a retrospective cohort study of pediatric emergency department (PED) visits at the Montreal Children's Hospital using the Système Informatique Urgence (SIURGE), electronic medical record database. We analysed the relation between patient's characteristics and the number of PED visits over a 1-year period following the index visit.

Results: Patients totalling 52,088 accounted for 94,155 visits. Of those, 2,474 (4.7%) patients had five and more recurrent visits and accounted for 16.6% (15,612 visits) of the total PED visits. Lower level of acuity at index visit (odds ratio [OR] 0.85) was associated with a lower number of recurrent visits. Lower socioeconomic status (social deprivation index OR 1.09, material deprivation index OR 1.08) was associated with a higher number of recurrent visits. Asthma (OR 1.57); infectious ear, nose, and sinus disorders (OR 1.33); and other respiratory disorders (OR 1.56) were independently associated with a higher incidence of a recurrent visit within the year following the first visit.

Conclusion: Our study is the first Canadian study to assess risk factors of frequent pediatric emergency use. The identified risk factors and diagnoses highlight the need for future evidence-based, targeted innovative research evaluating strategies to minimize ED crowding, to improve health outcomes and to improve patient satisfaction.
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May 2018

Increased Risk of Asthma in Children with ADHD: Role of Prematurity and Maternal Stress during Pregnancy.

J Can Acad Child Adolesc Psychiatry 2015 31;24(2):109-15. Epub 2015 Aug 31.

Douglas Mental Health University Institute, Montreal, Quebec ; Department of Human Genetics, McGill University, Montreal, Quebec.

Objective: ADHD and asthma are prevalent conditions in childhood, with complex pathophysiology involving genetic-environmental interplay. The study objective is to examine the prevalence of asthma in our ADHD population and explore factors that may increase the risk of developing asthma in children with ADHD.

Methods: We retrospectively analyzed the presence of maternal stress during pregnancy and history of asthma in 201 children diagnosed with ADHD.

Results: Chi-square analysis indicated significant higher presence of asthma in our ADHD sample compared to Quebec children, χ(2)(1, N = 201) = 15.37, P<0.001. Only prematurity and stress during pregnancy significantly predicted asthma in a logistic regression model, χ(2)(2)=23.70, P<0.001, with odds ratios of 10.6 (95% CI: 2.8-39.5) and 3.2 (95% CI: 1.4-7.3), respectively.

Conclusion: Children with ADHD have a higher prevalence of asthma than the general Quebec pediatric population. Children with ADHD born prematurely and/or those whose mothers experienced stress during pregnancy have a significantly increased risk of developing asthma. The study highlights the importance of potentially offering social and psychological support to mothers who experienced stress during pregnancy and/or are at risk of delivering prematurely.
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September 2015