Karen Bailey - Academia.edu (original) (raw)

Papers by Karen Bailey

Journal of Pediatric Surgery Case Reports, 2013

Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors. Most present with nonspecific... more Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors. Most present with nonspecific symptoms. We present a case of a 17-year-old male with sudden abdominal pain. Imaging revealed a hypodense mass inferior to the stomach. Serial blood work showed a decreasing hemoglobin level. In the operating room a pedunculated, torted, hemorrhagic mass on the anterior surface of the stomach was resected. Pathology confirmed a GIST, c-kit positive with involved margins. The patient was started on imatinib. Pediatric GISTS are different than adult GISTs; the majority are c-kit negative (wild-type) and typically indolent. Despite a high recurrence rate, aggressive resection of pediatric GIST is generally not indicated. This pediatric GISTs was c-kit and PDGFR exon 18 mutation positive and thus was treated according to the National Comprehensive Cancer Network (NCCN) guidelines (for adults).

Paediatrics & Child Health

Objective: This qualitative study explored attitudes toward weight management and knowledge of he... more Objective: This qualitative study explored attitudes toward weight management and knowledge of healthy, active living among paediatric patients referred to a weight management program. The objective of this study was to determine the emotional state and attitudes of patients entering into a paediatric weight management program. Methods: Study participants (aged 7 to 17 years old) were recruited during clinic orientation. Semistructured interviews were conducted, audiotaped and transcribed verbatim. Qualitative content analysis generated a thematic coding scheme, identifying concepts and linkages in the data. Study rigour was achieved collaboratively through an audit trail, and data triangulation. Results: Fifteen patients (median age 11 years) consented to interviews. Three recurring themes emerged: emotions, motivation and learning. A total of nine subthemes were identified. Four key spheres of influence (family, peers, school and health care providers) affected the patient's outlook on obesity positively by providing support or negatively by adversely influencing their emotions and motivation. The level of individual motivation to engage in the weight management program varied. A positive outlook toward learning about obesity from school officials and health care providers emerged. Conclusions: This study provided insight regarding paediatric attitudes related to entering a weight management program. The negative emotional state and sometimes fear of the program expressed should be considered by the referring physician and by clinicians in weight management programs engaging in their care.

Journal of pediatric surgery, 2018

The "cut and push" technique for removal of percutaneous endoscopic gastrostomy (PEG) t... more The "cut and push" technique for removal of percutaneous endoscopic gastrostomy (PEG) tubes with collapsible bumpers offers an alternative to the standard traction method of removal. This study compared the outcomes of these techniques. We completed a research ethics board-approved retrospective cohort study, identifying all patients less than 18years of age who underwent PEG tube removal at a children's hospital between December 2013 and December 2016. Outcomes included need for sedation and complications. We identified 127 children who had PEG tubes removed. Significantly fewer children required sedation with the cut and push group (1.1% vs. 60.6%, p≤0.001). Ten complications occurred, including 9 in the cut and push group (9.6% vs. 3%, p=0.23). Mean age at time of complication was significantly younger in the cut and push group (2.2 vs. 6.3years p=0.004). This is the largest reported series comparing the cut and push vs. traction removal methods. The cut and push te...

World Journal of Clinical Pediatrics, 2017

To examine the extent to which the theory of planned behavior (TPB) predicts academic clinicians'... more To examine the extent to which the theory of planned behavior (TPB) predicts academic clinicians' intent to treat pediatric obesity.

Critical Care Clinics, 2010

Childhood obesity (Print), Jan 18, 2015

Although most clinicians agree that obesity is a major problem, treatment rates remain low. We co... more Although most clinicians agree that obesity is a major problem, treatment rates remain low. We conducted this discrete choice experiment (DCE) to understand academic clinicians' decisions in treating childhood obesity. A total of 198 academic pediatric surgeons, pediatricians, family physicians, and allied health professionals were recruited from 15 teaching hospitals across Canada to participate in this DCE. Participants completed 15 tasks choosing between three obesity treatment scenarios to identify the scenario in which they would most likely treat pediatric obesity. Latent class analysis revealed two classes with early intervention and late intervention preferences. Participants in the early intervention group (30%) were sensitive to variations in patient and family support. They would likely intervene if patients were obese, with normal lipid levels, were prediabetic, had high blood pressure, and when obesity was lifestyle associated. Late intervention clinicians (70%) wer...

Canadian Journal of Diabetes, 2015

Journal of Pediatric Surgery Case Reports, 2013

African journal of paediatric surgery : AJPS

This survey compared surgical management of Hirschsprung's disease (HD) and anorectal malform... more This survey compared surgical management of Hirschsprung's disease (HD) and anorectal malformations (ARM) in high and low resource settings. An online survey was sent to 208 members of the Canadian Association of Paediatric Surgeons (CAPS) and the Association of Paediatric Surgeons of Nigeria (APSON). The response rate was 76.8% with 127 complete surveys (APSON 34, CAPS 97). Only 29.5% of APSON surgeons had frozen section available for diagnosis of HD. They were more likely to choose full thickness rectal biopsy (APSON 70.6% vs. CAPS 9.4%, P < 0.05) and do an initial colostomy for HD (APSON 23.5% vs. CAPS 0%, P < 0.05). Experience with trans-anal pull-through for HD was similar in both groups (APSON 76.5%, CAPS 66.7%). CAPS members practising in the United States were more likely to perform a one-stage pull-through for HD during the initial hospitalization (USA 65.4% vs. Canada 28.3%, P…

Pediatric and Developmental Pathology, 2005

A 16-year-old girl presented with hematochezia and abdominal pain. The patient developed a small ... more A 16-year-old girl presented with hematochezia and abdominal pain. The patient developed a small bowel obstruction that required a laparotomy, which showed a segment of grossly infarcted small bowel with 3 perforations, localized abscesses, and creeping fat. Resection and an end-to-end anastomosis were performed. Pathologic examination showed underlying mesenteric venous thrombosis with no evidence of Crohn's disease. Hematology workup showed no evidence of a congenitally inherent hypercoagulable state. The use of oral contraceptives was the only predisposing factor identified.

Journal of Pediatric Surgery, 2007

Background: The role of laparoscopic surgery in treating intussusception has been controversial. ... more Background: The role of laparoscopic surgery in treating intussusception has been controversial. This study reviews our institution's experience with the laparoscopic approach (LAP) compared to the open surgical approach (OPEN). Methods: Retrospective analysis of all patients undergoing surgery for intussusception at our center from January 2002 to February 2006. Statistical assessment included Student's t test and v 2 analysis. Results: A total of 41 patients required operation for intussusception (18 LAP, 23 OPEN). Mean age was 22 months for LAP and 11 months for OPEN ( P = .17). In the LAP group, 28% (5/18) were converted to an open procedure. Operative times and complications were not significantly different. Pathologic lead points were found in 33% (6/18) LAP and 35% (8/23) OPEN patients ( P = 1.0). Time to full feeds was significantly shorter (LAP vs OPEN: 3.4 F 2.7 vs 5.6 F 3.4 days, P = .02). Length of stay was shorter (LAP vs OPEN: 4.8 F 3.5 vs 9.1 F 7.5 days, P = .03). Conclusions: Intussusception can be treated safely and effectively using a LAP with a significant decrease in time to full feeds and length of stay. The LAP should be considered as the initial approach for stable patients with intussusception requiring operative intervention. D

Journal of Pediatric Surgery, 2008

Purpose: Normal gut muscular function depends on the coordinated activity of both the enteric ner... more Purpose: Normal gut muscular function depends on the coordinated activity of both the enteric nervous system (ENS) and the interstitial cells of Cajal (ICC). Hirschsprung's disease (HD) has long been considered a purely neuronal deficit but recent data point to abnormalities in ICC in the proximal ganglionated HD colon. We examined the labeling of ICC and neuronal cells in the proximal ganglionated colon in patients with HD to determine whether abnormalities of ICC and ENS might be associated with a poor clinical outcome. Methods: Tissue from 11 patients with HD was studied using immunohistochemistry for ICC and neuronal identification in comparison to control tissue from patients without HD. Image data were evaluated quantitatively and interpreted relative to clinical outcome. Results: Interstitial cells of Cajal in the ganglionated colon of the HD group did not differ from the control group, but nerve cells/fibers were decreased 40%. Paired decreases in both nerve fibers and ICC in individual patients were associated with normal bowel function. Poor postoperative outcome was observed in a patient with normal innervation but with a profound decrease in ICC in the ganglionated colon. Conclusions: Nerve fibers are decreased in the proximal ganglionated colon in patients with HD without associated gut dysmotility. Poor clinical outcome was noted only in a patient with normal innervation and markedly decreased ICC. Collection of data from a much larger number of patients with poor clinical outcome will be necessary to determine the significance of this imbalance of ICC and innervation.

Journal of Pediatric Surgery, 2013

Background: This qualitative study aims to understand academic physicians' attitudes towards the ... more Background: This qualitative study aims to understand academic physicians' attitudes towards the treatment of pediatric obesity in Canada. Methods: A stratified sample of 24 participants (surgeons, pediatricians, family practitioners) were recruited from 4 Canadian regions. Semi-structured interviews were conducted and transcribed. A codebook was developed through iterative data reduction and conceptual saturation ensured. Validity was ensured through triangulation, audit trail, and member-checking. Results: This study revealed 45 themes with regional, specialty, and experiential differences. Quebec and Ontario emphasized education of physicians and parents to improve treatment and favored surgical intervention. Half of surgeons felt surgery was the only successful treatment option, while non-surgeons favored behavioral interventions. Experienced physicians in Western Canada desired more evidence to improve patient care, while inexperienced physicians focused on early detection and home environments. Across Canada participants advocated for program development and system change. Respondents expressed family involvement as integral to treatment success and shifting away from blame and moving towards a healthy lifestyles approach. Conclusions: Canadian regional differences in physicians' attitudes towards pediatric obesity treatment exist, influenced by experience and specialty. We will understand how themes identified in this study influence real life clinical decision making by applying these results to create a discrete choice-based conjoint survey.

Journal of Pediatric Surgery, 2013

Introduction: While pediatric surgeons consider gastrostomy to be routine treatment for children ... more Introduction: While pediatric surgeons consider gastrostomy to be routine treatment for children with feeding difficulties, the impact on the family is not fully understood. This study focuses on Quality of Life (QoL) of parents of children who require a gastrostomy tube. A total of 31 caregivers were recruited with a mean age of 32.6 years (SD=7.0). Overall, a 38% increased risk of depression was seen in the SF-36 when compared to population norms, and a moderate effect was seen in mental health at 12 months (ES = 0.56). The CSI demonstrated a decrease in caregiver burden (8.72 to 7.05, p = 0.007, 95% CI (0.57-3.18)), while the PECI revealed a decrease in frequency of feelings of guilt, worry, sorrow, anger, and long term uncertainty over 12 months. Conclusion: Gastrostomy not only improves the child's physical health, but also improves the mental health of the child's caregivers, especially at (or after) one year.

Journal of pediatric surgery, 2012

High-quality prospective cohort studies are needed to answer research questions focused on progno... more High-quality prospective cohort studies are needed to answer research questions focused on prognosis. To determine the feasibility of conducting this type of research, a prospective cohort study focused on investigating health-related quality of life (HRQoL) of caregivers of children who require a gastrostomy (G) tube at the McMaster Children's Hospital was piloted from November 2009 to May 2011.

Journal of Laparoendoscopic & Advanced Surgical Techniques, 2005

We reviewed empyema management at our center since video-assisted thoracoscopic surgery (VATS) wa... more We reviewed empyema management at our center since video-assisted thoracoscopic surgery (VATS) was introduced. Between 1991 and 2003, 58 patients (34 male, 24 female) ages 1 day to 17 years (median, 6 years) were identified. The median interval from the onset of symptoms to presentation was 7 days; 31% of patients received inpatient care at another hospital, and 24% were from northern communities, including the Arctic. Symptoms included fever (100%), cough (66%), shortness of breath (46%), chest pain (38%), and abdominal pain (17%). Most patients (96%) had pneumonia. The most common organisms were Streptococcus pneumoniae (22%), group A streptococcus (8%), and Mycobacterium tuberculosis (3%). No organisms were identified in 31% of patients. One empyema was trauma-related and one was due to complications of esophageal stricturoplasty. All patients received intravenous antibiotics (median, 17 days). Three patients had thoracentesis, 17 had chest tubes, 3 had thoracentesis and chest tubes, 26 had VATS, 6 had thoracotomy, and 3 had minithoracotomy. Median operative times were 86 minutes for VATS, 90 minutes for thoracotomy, and 75 minutes for minithoracotomy. Median total length of stay (LOS) was 15 days for VATS, 20.5 days for thoracotomy, and 21 days for minithoracotomy. The median preoperative LOS was longer for thoracotomy (10 days) than for VATS (5 days) or minithoracotomy (1 day). The median postoperative LOS was 14 days for VATS, 9.5 days for thoracotomy, and 8 days for minithoracotomy. Our experience shows that VATS is a safe and effective approach to managing children with empyema. The shorter preoperative LOS for VATS is likely due to earlier surgical referral and intervention using less invasive surgical procedures.

Critical Care Clinics, 2010

Obesity has been recognized as an increasing problem not only in North America but globally. With... more Obesity has been recognized as an increasing problem not only in North America but globally. With a significant rise in the prevalence of obesity amongst children and adolescents over the past 20 years, the comorbidities associated with obesity are also now emerging at an earlier age. These comorbidities cause specific concern and require special consideration when the morbidly obese child becomes critically ill.

Clinical Medicine & Research, 2010

Background: A sufficient daily consumption of fruits and vegetables (F&V) could help prevent chro... more Background: A sufficient daily consumption of fruits and vegetables (F&V) could help prevent chronic diseases. Since implementing the 5 A Day program, research has shown that awareness has increased, but average F&V intake among American adults remains under the minimum recommendation. This analysis examines factors related to increasing F&V intake among participants in the MENU study, a randomized trial with two intervention arms and one control arm. Methods: In 2005, 2,513 confirmed HMO members, aged 21 -65, from five geographically-diverse health plans completed an online enrollment survey, reporting F&V intake and personal and family health history. Mean change in combined F&V servings per day was assessed at 12 months post baseline, using a validated self -report F&V food frequency questionnaire. Analysis of covariance adjusting for the baseline F&V intake, regardless of study arm, was performed for each factor considered. Results: Of the 2,513, 80% were followed up at 12 months. Those with a family history of hypertension or diabetes increased their F&V consumption, P=.03 and P=.04 compared to those with no family history of these conditions, regardless of race. There were no observed differences in consumption increase by reported family history of cancer, heart disease or obesity. Participants with a high perceived risk of developing diabetes increased their intake by more than 0.6 servings than those with no perceived diabetes risk, P=.05, regardless of race. There were no statistical differences for consumption increase by risk of hypertension, heart disease or obesity. We tested for interactions between race and family history (FH) and perceived risk (PR) individually for each condition. Only FH of obesity was significant, P=.09 showing that whites with FH were more likely to increase F&V intake while blacks were not. The only significant interaction for PR was PR of cancer, P=.07. Interestingly, while the overall change was not significant for either race, whites with high PR increased F&V and blacks with a low PR increased F&V. Conclusion: FH of hypertension and diabetes, as well as perceived higher risk for developing diabetes, were characteristics that contributed to increasing F&V consumption, regardless of race. FH of obesity and PR of cancer contributed to differences in F&V intake change between blacks and whites. Interventions addressing perceived risk of disease or family history of disease may be valuable in encouraging dietary lifestyle.

Genome biology, Jan 14, 2002

A report from the 14th Biennial Meeting of the International Society for Developmental Neuroscien... more A report from the 14th Biennial Meeting of the International Society for Developmental Neuroscience, Sydney, Australia, 31 January to 4 February 2002.

Journal of Pediatric Surgery Case Reports, 2013

Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors. Most present with nonspecific... more Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors. Most present with nonspecific symptoms. We present a case of a 17-year-old male with sudden abdominal pain. Imaging revealed a hypodense mass inferior to the stomach. Serial blood work showed a decreasing hemoglobin level. In the operating room a pedunculated, torted, hemorrhagic mass on the anterior surface of the stomach was resected. Pathology confirmed a GIST, c-kit positive with involved margins. The patient was started on imatinib. Pediatric GISTS are different than adult GISTs; the majority are c-kit negative (wild-type) and typically indolent. Despite a high recurrence rate, aggressive resection of pediatric GIST is generally not indicated. This pediatric GISTs was c-kit and PDGFR exon 18 mutation positive and thus was treated according to the National Comprehensive Cancer Network (NCCN) guidelines (for adults).

Paediatrics & Child Health

Objective: This qualitative study explored attitudes toward weight management and knowledge of he... more Objective: This qualitative study explored attitudes toward weight management and knowledge of healthy, active living among paediatric patients referred to a weight management program. The objective of this study was to determine the emotional state and attitudes of patients entering into a paediatric weight management program. Methods: Study participants (aged 7 to 17 years old) were recruited during clinic orientation. Semistructured interviews were conducted, audiotaped and transcribed verbatim. Qualitative content analysis generated a thematic coding scheme, identifying concepts and linkages in the data. Study rigour was achieved collaboratively through an audit trail, and data triangulation. Results: Fifteen patients (median age 11 years) consented to interviews. Three recurring themes emerged: emotions, motivation and learning. A total of nine subthemes were identified. Four key spheres of influence (family, peers, school and health care providers) affected the patient's outlook on obesity positively by providing support or negatively by adversely influencing their emotions and motivation. The level of individual motivation to engage in the weight management program varied. A positive outlook toward learning about obesity from school officials and health care providers emerged. Conclusions: This study provided insight regarding paediatric attitudes related to entering a weight management program. The negative emotional state and sometimes fear of the program expressed should be considered by the referring physician and by clinicians in weight management programs engaging in their care.

Journal of pediatric surgery, 2018

The "cut and push" technique for removal of percutaneous endoscopic gastrostomy (PEG) t... more The "cut and push" technique for removal of percutaneous endoscopic gastrostomy (PEG) tubes with collapsible bumpers offers an alternative to the standard traction method of removal. This study compared the outcomes of these techniques. We completed a research ethics board-approved retrospective cohort study, identifying all patients less than 18years of age who underwent PEG tube removal at a children's hospital between December 2013 and December 2016. Outcomes included need for sedation and complications. We identified 127 children who had PEG tubes removed. Significantly fewer children required sedation with the cut and push group (1.1% vs. 60.6%, p≤0.001). Ten complications occurred, including 9 in the cut and push group (9.6% vs. 3%, p=0.23). Mean age at time of complication was significantly younger in the cut and push group (2.2 vs. 6.3years p=0.004). This is the largest reported series comparing the cut and push vs. traction removal methods. The cut and push te...

World Journal of Clinical Pediatrics, 2017

To examine the extent to which the theory of planned behavior (TPB) predicts academic clinicians'... more To examine the extent to which the theory of planned behavior (TPB) predicts academic clinicians' intent to treat pediatric obesity.

Critical Care Clinics, 2010

Childhood obesity (Print), Jan 18, 2015

Although most clinicians agree that obesity is a major problem, treatment rates remain low. We co... more Although most clinicians agree that obesity is a major problem, treatment rates remain low. We conducted this discrete choice experiment (DCE) to understand academic clinicians' decisions in treating childhood obesity. A total of 198 academic pediatric surgeons, pediatricians, family physicians, and allied health professionals were recruited from 15 teaching hospitals across Canada to participate in this DCE. Participants completed 15 tasks choosing between three obesity treatment scenarios to identify the scenario in which they would most likely treat pediatric obesity. Latent class analysis revealed two classes with early intervention and late intervention preferences. Participants in the early intervention group (30%) were sensitive to variations in patient and family support. They would likely intervene if patients were obese, with normal lipid levels, were prediabetic, had high blood pressure, and when obesity was lifestyle associated. Late intervention clinicians (70%) wer...

Canadian Journal of Diabetes, 2015

Journal of Pediatric Surgery Case Reports, 2013

African journal of paediatric surgery : AJPS

This survey compared surgical management of Hirschsprung's disease (HD) and anorectal malform... more This survey compared surgical management of Hirschsprung's disease (HD) and anorectal malformations (ARM) in high and low resource settings. An online survey was sent to 208 members of the Canadian Association of Paediatric Surgeons (CAPS) and the Association of Paediatric Surgeons of Nigeria (APSON). The response rate was 76.8% with 127 complete surveys (APSON 34, CAPS 97). Only 29.5% of APSON surgeons had frozen section available for diagnosis of HD. They were more likely to choose full thickness rectal biopsy (APSON 70.6% vs. CAPS 9.4%, P < 0.05) and do an initial colostomy for HD (APSON 23.5% vs. CAPS 0%, P < 0.05). Experience with trans-anal pull-through for HD was similar in both groups (APSON 76.5%, CAPS 66.7%). CAPS members practising in the United States were more likely to perform a one-stage pull-through for HD during the initial hospitalization (USA 65.4% vs. Canada 28.3%, P…

Pediatric and Developmental Pathology, 2005

A 16-year-old girl presented with hematochezia and abdominal pain. The patient developed a small ... more A 16-year-old girl presented with hematochezia and abdominal pain. The patient developed a small bowel obstruction that required a laparotomy, which showed a segment of grossly infarcted small bowel with 3 perforations, localized abscesses, and creeping fat. Resection and an end-to-end anastomosis were performed. Pathologic examination showed underlying mesenteric venous thrombosis with no evidence of Crohn's disease. Hematology workup showed no evidence of a congenitally inherent hypercoagulable state. The use of oral contraceptives was the only predisposing factor identified.

Journal of Pediatric Surgery, 2007

Background: The role of laparoscopic surgery in treating intussusception has been controversial. ... more Background: The role of laparoscopic surgery in treating intussusception has been controversial. This study reviews our institution's experience with the laparoscopic approach (LAP) compared to the open surgical approach (OPEN). Methods: Retrospective analysis of all patients undergoing surgery for intussusception at our center from January 2002 to February 2006. Statistical assessment included Student's t test and v 2 analysis. Results: A total of 41 patients required operation for intussusception (18 LAP, 23 OPEN). Mean age was 22 months for LAP and 11 months for OPEN ( P = .17). In the LAP group, 28% (5/18) were converted to an open procedure. Operative times and complications were not significantly different. Pathologic lead points were found in 33% (6/18) LAP and 35% (8/23) OPEN patients ( P = 1.0). Time to full feeds was significantly shorter (LAP vs OPEN: 3.4 F 2.7 vs 5.6 F 3.4 days, P = .02). Length of stay was shorter (LAP vs OPEN: 4.8 F 3.5 vs 9.1 F 7.5 days, P = .03). Conclusions: Intussusception can be treated safely and effectively using a LAP with a significant decrease in time to full feeds and length of stay. The LAP should be considered as the initial approach for stable patients with intussusception requiring operative intervention. D

Journal of Pediatric Surgery, 2008

Purpose: Normal gut muscular function depends on the coordinated activity of both the enteric ner... more Purpose: Normal gut muscular function depends on the coordinated activity of both the enteric nervous system (ENS) and the interstitial cells of Cajal (ICC). Hirschsprung's disease (HD) has long been considered a purely neuronal deficit but recent data point to abnormalities in ICC in the proximal ganglionated HD colon. We examined the labeling of ICC and neuronal cells in the proximal ganglionated colon in patients with HD to determine whether abnormalities of ICC and ENS might be associated with a poor clinical outcome. Methods: Tissue from 11 patients with HD was studied using immunohistochemistry for ICC and neuronal identification in comparison to control tissue from patients without HD. Image data were evaluated quantitatively and interpreted relative to clinical outcome. Results: Interstitial cells of Cajal in the ganglionated colon of the HD group did not differ from the control group, but nerve cells/fibers were decreased 40%. Paired decreases in both nerve fibers and ICC in individual patients were associated with normal bowel function. Poor postoperative outcome was observed in a patient with normal innervation but with a profound decrease in ICC in the ganglionated colon. Conclusions: Nerve fibers are decreased in the proximal ganglionated colon in patients with HD without associated gut dysmotility. Poor clinical outcome was noted only in a patient with normal innervation and markedly decreased ICC. Collection of data from a much larger number of patients with poor clinical outcome will be necessary to determine the significance of this imbalance of ICC and innervation.

Journal of Pediatric Surgery, 2013

Background: This qualitative study aims to understand academic physicians' attitudes towards the ... more Background: This qualitative study aims to understand academic physicians' attitudes towards the treatment of pediatric obesity in Canada. Methods: A stratified sample of 24 participants (surgeons, pediatricians, family practitioners) were recruited from 4 Canadian regions. Semi-structured interviews were conducted and transcribed. A codebook was developed through iterative data reduction and conceptual saturation ensured. Validity was ensured through triangulation, audit trail, and member-checking. Results: This study revealed 45 themes with regional, specialty, and experiential differences. Quebec and Ontario emphasized education of physicians and parents to improve treatment and favored surgical intervention. Half of surgeons felt surgery was the only successful treatment option, while non-surgeons favored behavioral interventions. Experienced physicians in Western Canada desired more evidence to improve patient care, while inexperienced physicians focused on early detection and home environments. Across Canada participants advocated for program development and system change. Respondents expressed family involvement as integral to treatment success and shifting away from blame and moving towards a healthy lifestyles approach. Conclusions: Canadian regional differences in physicians' attitudes towards pediatric obesity treatment exist, influenced by experience and specialty. We will understand how themes identified in this study influence real life clinical decision making by applying these results to create a discrete choice-based conjoint survey.

Journal of Pediatric Surgery, 2013

Introduction: While pediatric surgeons consider gastrostomy to be routine treatment for children ... more Introduction: While pediatric surgeons consider gastrostomy to be routine treatment for children with feeding difficulties, the impact on the family is not fully understood. This study focuses on Quality of Life (QoL) of parents of children who require a gastrostomy tube. A total of 31 caregivers were recruited with a mean age of 32.6 years (SD=7.0). Overall, a 38% increased risk of depression was seen in the SF-36 when compared to population norms, and a moderate effect was seen in mental health at 12 months (ES = 0.56). The CSI demonstrated a decrease in caregiver burden (8.72 to 7.05, p = 0.007, 95% CI (0.57-3.18)), while the PECI revealed a decrease in frequency of feelings of guilt, worry, sorrow, anger, and long term uncertainty over 12 months. Conclusion: Gastrostomy not only improves the child's physical health, but also improves the mental health of the child's caregivers, especially at (or after) one year.

Journal of pediatric surgery, 2012

High-quality prospective cohort studies are needed to answer research questions focused on progno... more High-quality prospective cohort studies are needed to answer research questions focused on prognosis. To determine the feasibility of conducting this type of research, a prospective cohort study focused on investigating health-related quality of life (HRQoL) of caregivers of children who require a gastrostomy (G) tube at the McMaster Children's Hospital was piloted from November 2009 to May 2011.

Journal of Laparoendoscopic & Advanced Surgical Techniques, 2005

We reviewed empyema management at our center since video-assisted thoracoscopic surgery (VATS) wa... more We reviewed empyema management at our center since video-assisted thoracoscopic surgery (VATS) was introduced. Between 1991 and 2003, 58 patients (34 male, 24 female) ages 1 day to 17 years (median, 6 years) were identified. The median interval from the onset of symptoms to presentation was 7 days; 31% of patients received inpatient care at another hospital, and 24% were from northern communities, including the Arctic. Symptoms included fever (100%), cough (66%), shortness of breath (46%), chest pain (38%), and abdominal pain (17%). Most patients (96%) had pneumonia. The most common organisms were Streptococcus pneumoniae (22%), group A streptococcus (8%), and Mycobacterium tuberculosis (3%). No organisms were identified in 31% of patients. One empyema was trauma-related and one was due to complications of esophageal stricturoplasty. All patients received intravenous antibiotics (median, 17 days). Three patients had thoracentesis, 17 had chest tubes, 3 had thoracentesis and chest tubes, 26 had VATS, 6 had thoracotomy, and 3 had minithoracotomy. Median operative times were 86 minutes for VATS, 90 minutes for thoracotomy, and 75 minutes for minithoracotomy. Median total length of stay (LOS) was 15 days for VATS, 20.5 days for thoracotomy, and 21 days for minithoracotomy. The median preoperative LOS was longer for thoracotomy (10 days) than for VATS (5 days) or minithoracotomy (1 day). The median postoperative LOS was 14 days for VATS, 9.5 days for thoracotomy, and 8 days for minithoracotomy. Our experience shows that VATS is a safe and effective approach to managing children with empyema. The shorter preoperative LOS for VATS is likely due to earlier surgical referral and intervention using less invasive surgical procedures.

Critical Care Clinics, 2010

Obesity has been recognized as an increasing problem not only in North America but globally. With... more Obesity has been recognized as an increasing problem not only in North America but globally. With a significant rise in the prevalence of obesity amongst children and adolescents over the past 20 years, the comorbidities associated with obesity are also now emerging at an earlier age. These comorbidities cause specific concern and require special consideration when the morbidly obese child becomes critically ill.

Clinical Medicine & Research, 2010

Background: A sufficient daily consumption of fruits and vegetables (F&V) could help prevent chro... more Background: A sufficient daily consumption of fruits and vegetables (F&V) could help prevent chronic diseases. Since implementing the 5 A Day program, research has shown that awareness has increased, but average F&V intake among American adults remains under the minimum recommendation. This analysis examines factors related to increasing F&V intake among participants in the MENU study, a randomized trial with two intervention arms and one control arm. Methods: In 2005, 2,513 confirmed HMO members, aged 21 -65, from five geographically-diverse health plans completed an online enrollment survey, reporting F&V intake and personal and family health history. Mean change in combined F&V servings per day was assessed at 12 months post baseline, using a validated self -report F&V food frequency questionnaire. Analysis of covariance adjusting for the baseline F&V intake, regardless of study arm, was performed for each factor considered. Results: Of the 2,513, 80% were followed up at 12 months. Those with a family history of hypertension or diabetes increased their F&V consumption, P=.03 and P=.04 compared to those with no family history of these conditions, regardless of race. There were no observed differences in consumption increase by reported family history of cancer, heart disease or obesity. Participants with a high perceived risk of developing diabetes increased their intake by more than 0.6 servings than those with no perceived diabetes risk, P=.05, regardless of race. There were no statistical differences for consumption increase by risk of hypertension, heart disease or obesity. We tested for interactions between race and family history (FH) and perceived risk (PR) individually for each condition. Only FH of obesity was significant, P=.09 showing that whites with FH were more likely to increase F&V intake while blacks were not. The only significant interaction for PR was PR of cancer, P=.07. Interestingly, while the overall change was not significant for either race, whites with high PR increased F&V and blacks with a low PR increased F&V. Conclusion: FH of hypertension and diabetes, as well as perceived higher risk for developing diabetes, were characteristics that contributed to increasing F&V consumption, regardless of race. FH of obesity and PR of cancer contributed to differences in F&V intake change between blacks and whites. Interventions addressing perceived risk of disease or family history of disease may be valuable in encouraging dietary lifestyle.

Genome biology, Jan 14, 2002

A report from the 14th Biennial Meeting of the International Society for Developmental Neuroscien... more A report from the 14th Biennial Meeting of the International Society for Developmental Neuroscience, Sydney, Australia, 31 January to 4 February 2002.