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Abstract Body

Primary care is practiced, predominantly, in a reactive manner; patients present and receive care in response to findings. In contrast to this model, proactive healthcare involves active management of the patient population with the aim of disease prevention.

At Clalit, the largest health care organization in Israel, C-Pi (Clalit Proactive-Preventive Intervention) has been developed and deployed, specifically, to deal with challenges preventing physicians and nurses from delivering proactive healthcare.

The platform presents lists of ‘target populations’ - patients with increased predicted risk of specific outcomes across the clinical spectrum (e.g. diabetic or cardiovascular patients) to physicians, nurses and other healthcare practitioners. These lists focus on patients with the highest personalized risk, as generated using machine learning or directly from personal data from Clalit's rich electronic medical record (EMR). The risk is integrated with up-to-date clinical recommendations derived from up-to-date guidelines.

At a time when medical systems are being placed under increasing economic strain due to an ageing population, growing patient expectations and unprecedented growth of the medical arsenal, it is vital for healthcare organizations to be able to manage their resources at utmost efficiency. This paradigm shift is happening these days in Israel, using C-Pi platform.

Background and Aims

Background: Autism Spectrum Disorder (ASD) is a neurological disorder that affects sensory processing and verbal/nonverbal language abilities. Children are not diagnosed until 3-4 years when communication skills lag behind peers. Hence, there is a need for diagnostic biomarkers which predict ASD at a younger age.

Aim: Our aim is to develop a metabolomic assay in cord blood to identify infants at risk of ASD who could benefit from early intervention.

Methods

Participants: Cord blood from Danish National Birth Cohort (DNBC) was profiled for biomarker discovery. Our nested case:control study assessed 275 children with ASD vs 275 gender matched neurotypical controls.

Analysis: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was performed on Waters ACQUITY LC-SYNAPT G2-S. Progenesis-QI (Nonlinear Dynamics v2.4) aligned peaks and searched databases (e.g. Human Metabolome Database, KEGG) to match mass-to-charge values to chemical names. Peak data were exported to R and Python3 to explore machine learning (ML) algorithms which select biomarkers that discriminate between ASD and neurotypical outcomes.

Results

We profiled 1892 compounds and 20 clinical/lifestyle variables from the DNBC to identify the top metabolite and clinical features predictive of ASD . The top20 discriminatory metabolites as ranked by ML classifiers random forest and logistic regression models were selected for confirmation using analytical standards. Validation of biomarkers by LC-MS/MS on Waters Xevo TQMS is underway in independent samples from DNBC and Cork BASELINE Birth Cohort.

Conclusions

The markers identified in this study shed light on the molecular mechanisms implicated in the pathophysiology of ASD. Future work will focus on validating these putative markers.

Background and Aims

The use of virtual reality as a non-pharmacologic method may enable children to tolerate invasive procedures in a hospital setting easily and feel less pain. This study aimed to determine the effect of using a VR headset during venipuncture on pain level, heart rate and oxygen saturation values in children age 7-12 year-old.

Methods

This was a randomized controlled experimental study. This study included 102 children who visited the vaccination room of a pediatric outpatient clinic of a university hospital. Before venipuncture, state anxiety and pain scores of the children were evaluated. The children in the experimental group wore virtual reality headsets during venipuncture. The children in the control group underwent standard venipuncture procedure. Pain scores were evaluated again in both groups after the venipuncture. Before, during and after the venipuncture, pulse and oxygen saturation values were measured.

Results

It was determined that post-venipuncture pain mean scores were significantly lower in experimental group than those of the children in the control group (Z= -6.574; p=0.001). The mean heart rate during the procedure was significantly lower in the experimental group than in the control group (p=0.026; t=-2.265).

Conclusions

It was determined that post-venipuncture pain mean scores were significantly lower in experimental group than control group. Virtual reality is effective to reduce the pain of children during venipuncture. Virtual reality headsets may provide a comfortable intervention process for painful procedures. The virtual reality headsets may be recognized as effective instruments to reduce the pain level of children.

Background and Aims

Implementing Patient-reported Outcome Measures (PROMs) and Patient-reported Experience Measures (PREMs) is an effective way to deliver patient- and family-centered care (PFCC). Alberta Health Services (AHS) is Canada's largest and fully integrated health system, but PROMs and PREMs are not integrated into routine pediatric clinical care. Thus, this study investigated the current uptake, barriers, and enablers for integrating PROMs and PREMs in Alberta’s pediatric healthcare systems.

Methods

Pediatric clinicians and academic researchers with experience and interest in using PROMs and PREMs were invited to complete a quantitative survey to understand the current uptake and knowledge of using pediatric PROMs and PREMs in Alberta. Additionally, key stakeholders were qualitatively interviewed to understand their perspectives on the current challenges in implementing pediatric PROMs and PREMs within AHS.

Results

28 participants completed the quantitative survey. Participants work as pediatric clinicians within (AHS) or as researchers in academic institutions. There is much diversity in the mode of administration and types of pediatric PROMs and PREMs currently being used in Alberta. The primary analysis of 14 qualitative interviews shows that most participants acknowledge the importance of using PROMs and PREMs to provide PFCC, but some of them raised the issue of a lack of clear guidelines on using PROMs data in clinical care to improve healthcare delivery. The absence of system-level support, such as integration within electronic medical records systems, is considered a significant system-level challenge.

Conclusions

The findings from this study from Canada's largest integrated health system could apply to other pediatric healthcare settings worldwide.

Background and Aims

The United Nations Sustainable Development Goals are supported by the uptake of international ISO standards. The International Patient Summary, ISO 27269:2021, defines the core dataset to achieve continuity and coordination of healthcare.

At present health, data are locked in vendor dependent electronic records. The key is to give people easy access to their own data to help them understand their health and make more informed choices.

The aim is to illustrate how global harmonized interoperable standards give access to necessary data.

Methods

At a home visit, the nurse observed several skeletal deformities in 2 week old newborn. At 4 weeks during a routine health check achondroplasia was suspected and confirmed by DNA investigation. It was difficult for parents to understand why during pregnancy and after birth, these features were not mentioned. Requirements for exchanging the Birth Care data are available. The use case describes a profile of a child with a congenital anomaly detected before birth.

Results

International digital profile achondroplasia mother-child

Conclusions

The use case demonstrates how an international mother-child data profile provides a continuity of care to ensure appropriate guidance and practical support in primary child healthcare to leave no child behind.

Background and Aims

Child health data sharing and linkage has increased rapidly, along with increased secondary use of data in predictive analytics and models. While there is potential for societal and health gains when utilising large data sets, this also poses privacy and consent challenges, which appears relatively unknown to the public. Our aim was to understand the views of children, youth and their parents with regards to child health data storage, linkage and consent for data use.

Methods

We undertook five focus groups (26 participants) with children, teenagers and their parents/caregivers, informed by Kaupapa Māori theory principles (a decolonising response to systemic racism and its continuous effects on health outcomes). We covered six key domains: health data and information, data sovereignty, storage, sharing, linkage and consent. Data was analysed thematically.

Results

Firstly, health data was described as a unique and evolving “Health Story” – representing more than "just a number". Secondly, data represented power that allowed families to actively participate in their health journeys, with additional work required of families to navigate significant asymmetry of information within the health system. Finally, informed consent for child data use and linkage was conceived as an active relationship built on trust.

Conclusions

Findings suggest that a trusting relationship between health professionals and patients can facilitate open data sharing. This dynamic relationship must be revisited if intentions for data use change and when children reach an age where they can consent for themselves. Fair and informed consent processes have the potential to be healing relationships within the health system.

Background and Aims

To assess the clinical benefit offered by a 7-multistrain synbiotic (probiotics+prebiotics) over standard measures for the management of acute diarrhea of probable viral etiology in infants.

Methods

Multicenter, prospective, randomized, and controlled study, enrolling infants ≤2 years with acute diarrhea of less than 48 hours of evolution. Children were randomized into: Control group (CG) receiving only diet and oral rehydration therapy and Synbiotic group (SG) receiving, in addition, a liquid 7-multistrain synbiotic (Lactobacillus casei; Lactobacillus rhamnosus GG; Streptococcus thermophilus; Bifidobacterium breve; Lactobacillus acidophilus; Bifidobacterium infantis; Bifidobacterium bulgaricus plus Fructooligosaccharides) for 7 days. Study endpoints include evolution and resolution of diarrhea (WHO´s definition: ≥3 loose or liquid stools/day), feces consistency (Bristol scale), treatment tolerability and adherence.

Results

75 children were recruited [SG (n=40), CG (n=35)] and completed the 7-day treatment period. SG experienced less diarrhea (≥3 loose or watery stools/day for ≥3 consecutive days), 70.0% vs. 88.6% of patients in CG; p= 0.0502. Number of days with diarrhea -median (IQR 25-75)- were reduced in SG, 4 days (3-6.5) vs 6 days (5-7) in CG (p=0.002), with a lower duration of diarrhea episode -median (IQR 25-75)- (SG: 3 days (2-5), CG: 5 days (4-7); p=0.0006). Rate of recovery from diarrhea at the end of the study was higher for children receiving synbiotic, 85.0% (34/40), compared to control group, 54.3% (n=19/35); p=0.0036.

Conclusions

Synbiotic therapy improved the evolution and recovery from the diarrhea in children <3 years, providing additional benefit to standard supportive measures in the management of acute diarrhea of suspected viral origin.