Improving patient-centred care in the emergency department: Implementation of a Sensory Toolkit for children with autism.

Emergency department (ED) visits for children with autism can present challenges due to the unique sensory needs of this population. This Quality Improvement (QI) project executed two Plan-Do-Study-Act (PDSA) cycles to create and implement a Sensory Toolkit in the ED for children with autism. Most caregivers (94%; n = 31/33) and healthcare providers (HCPs; 86%; n = 37/44) identified the need for sensory items in the ED. In PDSA Cycle 1, 100% of caregivers (n = 21) and HCPs (n = 3) agreed/strongly agreed that the ED Sensory Toolkit was helpful. In PDSA Cycle 2, 92% of caregivers (n = 12/13) and 100% of HCPs (n = 3) agreed/strongly agreed that they were helpful. The Sensory Toolkit was positively evaluated by caregivers of children with autism and HCPs during the child's visit to the ED. There is an opportunity to adapt the Sensory Toolkit for other EDs and areas of the hospital.

A Quality Improvement Initiative to Reduce Necrotizing Enterocolitis in Very Preterm Infants.

OBJECTIVE: To reduce the incidence of necrotizing enterocolitis (NEC) among very preterm infants in the Calgary Health Region to ≤2% within 2 years. METHODS: A multidisciplinary team developed key drivers for NEC. Targeted interventions included strategies to increase mothers' own milk (MOM), improve compliance with feeding regimens, standardize management of feeding intolerance, prevent intestinal microbial aberrations, and feed conservatively during blood transfusion and the treatment of patent ductus arteriosus. The outcome measure was NEC (≥ stage 2). Changes in NEC rates were examined among racial and ethnic groups. Process measures included MOM feeding at discharge, the difference between actual and expected time to reach full feeds, lowest hemoglobin, and the duration of empirical antibiotics. Growth, the rate of blood transfusion, and the duration of parenteral nutrition were balancing measures. The preintervention, intervention, and sustainment periods were January 2013 to June 2016, July 2016 to December 2018, and December 2018 to December 2021, respectively. RESULTS: We included 2787 infants born at ≤326/7 weeks' gestation (1105 preintervention, 763 during intervention, and 919 in sustainment). NEC decreased from 5.6% to 1.9%. Process measures indicated increased MOM feeding at discharge, improved compliance with feeding regimens, increased lowest hemoglobin levels, and shorter durations of empirical antibiotics. Balancing measures revealed improved weight Z-scores, shorter durations on parenteral nutrition, and increased rates of blood transfusion. CONCLUSIONS: Quality improvement initiatives to increase MOM, improve compliance with feeding regimens, feed conservatively during blood transfusion and treatment of patent ductus arteriosus, and prevent intestinal microbial aberrations were associated with reduced NEC.

Unlicensed Molnupiravir is an Effective Rescue Treatment Following Failure of Unlicensed GS-441524-like Therapy for Cats with Suspected Feline Infectious Peritonitis.

Feline infectious peritonitis (FIP) is a complex and historically fatal disease, though recent advances in antiviral therapy have uncovered potential treatments. A newer therapeutic option, unlicensed molnupiravir, is being used as a first-line therapy for suspect FIP and as a rescue therapy to treat cats who have persistent or relapsed clinical signs of FIP after GS-441524 and/or GC376 therapy. Using owner-reported data, treatment protocols for 30 cats were documented. The 26 cats treated with unlicensed molnupiravir as a rescue therapy were treated with an average starting dosage of 12.8 mg/kg and an average ending dosage of 14.7 mg/kg twice daily for a median of 12 weeks (IQR = 10-15). In total, 24 of 26 cats were still living disease-free at the time of writing. One cat was euthanized after completing treatment due to a prolonged seizure, and the other cat underwent retreatment for relapsed clinical signs. Few adverse effects were reported, with the most notable-folded ears (1), broken whiskers (1), and severe leukopenia (1)-seen at dosages above 23 mg/kg twice daily. This study provides a proof of principle for the use of molnupiravir in cats and supports the need for future studies to further evaluate molnupiravir as a potentially safe and effective therapy for FIP.

Preventing Cardiovascular and Renal Disease in Canada's Aboriginal Populations.

Cardiovascular and renal disease are highly prevalent in Canada's Aboriginal population even though rates of cardiovascular disease are falling in the rest of the country. High and rising prevalence rates of diabetes must be addressed to impact significantly on global cardiovascular and renal risk. Type 2 diabetes is occurring in Aboriginal youth, putting them at greater risk of long-term complications. The reasons for the sudden upswing in diabetes rates in the past 60 years are a result in large part to social determinants of health, which for Aboriginal people include the multigenerational effects of colonization and consequences of the residential school system. Addressing cardiovascular and renal risk therefore requires the knowledge and skills to implement clinical practice guideline-based interventions, the ability to create culturally safe chronic disease management programs in partnership with Aboriginal communities, and advocacy across sectors for improvements in the social determinants of health.