Dawn Hartfield

Iron deficiency: A cause of stroke in infants and children

Iron deficiency is a common pediatric problem affecting 20%-25% of the worlds infants. Most commonly causing anemia, iron deficiency is also implicated in such neurologic sequelae as irritability, lethargy, headaches, developmental delay, and infrequently papilledema, pseudotumor cerebri, and cranial nerve abnormalities. Rarely has iron deficiency been recognized as a significant cause of stroke in the adult or pediatric populations. We report a series of 6 children, 6 to 18 months of age, who presented with an ischemic stroke or venous thrombosis after a viral prodrome. All patients had iron deficiency as a consistent finding among the group, and other known etiologies of childhood stroke were excluded. These patients provide evidence of a strong association between iron deficiency and ischemic events in children between 6 and 18 months of age.

The Association Between Iron Deficiency and Febrile Seizures in Childhood

Purpose. The purpose of this study was to determine the association between iron deficiency and febrile seizures in a large cohort of children aged 6 to 36 months. Methods. A retrospective case control study with 361 patients who presented with febrile seizures to the emergency department and 390 otherwise healthy controls who presented with a febrile illness to the emergency department were reviewed to determine iron status using the MCV, RDW, and hemoglobin. Results. A total of 9% of cases had iron deficiency (ID) and 6% had iron deficiency anemia (IDA), compared to 5% and 4% of controls respectively. The conditional logistic regression odds ratio for ID in patients with febrile seizures was 1.84 (95% CI, 1.02-3.31). Conclusion. Children with febrile seizures were almost twice as likely to be iron deficient as those with febrile illness alone. The results suggest that screening for ID should be considered in children presenting with febrile seizure.

Group A streptococcal meningitis as a complication of an infected capillary haemangioma.

We report a case of group A streptococcal meningitis in an infant resulting from an infected capillary haemangioma. The child suffered significant morbidity including cerebral infarction, epilepsy, and developmental delay. Treatment of infected capillary haemangiomas remains controversial and inconsistent. Conclusion: Our experience of this infant, resulting in profound neurological morbidity suggests that group A Streptococcus can be a virulent organism in the young child and that capillary haemangiomas must be treated aggressively at the first sign of infection.

The potential for nurses to contribute to and lead improvement science in health care

AIM A discussion of how nurses can contribute to and lead improvement science activities in health care. BACKGROUND Quality failures in health care have led to the urgent need for healthcare quality improvement. However, commonly quality improvement interventions proceed to practice implementation without rigorous methods or sufficient empirical evidence. This lack of evidence for quality improvement has led to the development of improvement science, which embodies quality improvement research and quality improvement practice. This paper discusses how the discipline of nursing and the nursing profession possesses many strengths that enable nurses to lead and to play an integral role in improvement science activities. However, we also discuss that there are insufficiencies in nursing education that require attention for nurses to truly contribute to and lead improvement science in health care. DESIGN Discussion paper. DATA SOURCES This paper builds on a collection of our previous work, a 12-month scoping review (March 2013-March 2014), baseline study on a quality improvement management system (Lean), interviews with nurses on quality improvement implementation and supporting literature. IMPLICATIONS FOR NURSING This paper highlights how nurses have the philosophical, theoretical, political and ethical positioning to contribute to and lead improvement science activities. However up to now, the potential for nurses to lead improvement science activities has not been fully used. CONCLUSION We suggest that one starting point is to include improvement science in nursing education curricula. Specifically, there needs to be increased focus on the nursing roles and skills needed to contribute to and lead healthcare improvement science activities.

Reversible Sideropenic Dysphagia in a Toddler With Iron Deficiency

Iron deficiency is the most common micronutrient deficiency in infants and toddlers. This vital micronutrient is involved in maintaining normal function at the cellular level, and its deficiency results in abnormalities of virtually every organ system. Disorders of swallowing associated with iron deficiency are well described in the adult literature. These include difficulties with glossal pain, alterations in esophageal motility without an anatomic abnormality, and Plummer–Vinson syndrome (PVS) with esophageal webs and rings. PVS is rare in the pediatric population, with most cases occurring in adolescence. Interestingly, specific studies looking for alterations in esophageal motility without anatomical abnormality in infants and young children with iron deficiency have not been performed. This is in spite of the high propensity for abnormal feeding practices in infants 12 to 24 months of age with iron deficiency whose diet consists largely of liquids and little solid food. The patient described is a male infant with progressive dysphagia with onset at 12 months of age and worsening until presentation at 20 months with severe iron deficiency anemia. He experienced complete resolution of his dysphagia within 1 week of treatment with ferrous sulfate.

An evaluation of a frontline led quality improvement initiative.

Purpose The Edmonton Zone, one of five Zones in Alberta Health Services (the health system in the province of Alberta, Canada), established a quality management framework (QMF) as a means to improve the delivery of high quality health care in the spring of 2014. The purpose of this research study was to understand the factors that facilitated or hindered the implementation of a quality improvement (QI) initiative for hand hygiene led by a newly formed frontline unit quality council (UQC), a part of the QMF, based out of the pediatric intensive care unit (PICU) at the Stollery Childrens Hospital in the Edmonton Zone. This research will provide an understanding of the newly established QMF in the Edmonton Zone and the factors needed to foster the ongoing development of frontline UQC that do improvement work as part of their daily routine. Design/methodology/approach Using a qualitative case study research design data were collected using semi-structured open-ended interviews with six key stakeholders (one registered nurse, one physician, one patient case manager, medical director for QI, clinical QI consultant and director of clinical QI) involved in UQC at the PICU. Findings Individual, unit and organizational level factors were identified as influencing the function of the UQC. Leadership and work culture were the key facilitating factors to success and lack of QI training and personnel/dedicated time were perceived barriers to completing the QI initiative. Originality/value The findings from this research illustrate that frontline UQC are able to impact positive sustained change early in their establishment as part of a larger QMF. It is important, however, for the system to foster ongoing development of capacity and capability of these frontline UQC to ensure sustained success of the larger systems change.

Corrigendum to “Comparative effectiveness of pediatric integrative medicine as an adjunct to usual care for pediatric inpatients of a North American tertiary care centre: A study protocol for a pragmatic cluster controlled trial” [Contemp. Clin. Trials Commun. (2017) 12–18]

[This corrects the article DOI: 10.1016/j.conctc.2016.11.002.].

Comparative effectiveness of pediatric integrative medicine as an adjunct to usual care for pediatric inpatients of a North American tertiary care centre: A study protocol for a pragmatic cluster controlled trial

Background Some pediatric tertiary care centres in North America supplement conventional care with complementary therapies, together known as pediatric integrative medicine (PIM). Evidence to support the safety and efficacy of PIM is emerging, but the cost-effectiveness of an inpatient PIM service has yet to be assessed. Methods/Design This study is a pragmatic cluster controlled clinical trial. Usual care will be compared to usual care augmented with PIM in three pediatric divisions; oncology, general medicine, and cardiology at one large urban tertiary care Canadian Childrens Hospital. The primary outcome of the feasibility study is enrolment; the primary outcome of the main study is cost-effectiveness. Other secondary outcomes include the prevalence and severity of key symptoms (i.e. pain, nausea/vomiting and anxiety), efficacy of PIM interventions, patient safety, and parent satisfaction. Discussion This trial will be the first to evaluate the comparative effectiveness, both clinical and cost, of a PIM inpatient service. The evidence from this study will be useful to families, clinicians and decision makers, and will describe the clinical and economic value of PIM services for pediatric patients admitted to hospital.