Montreal Children's Hospital

About: Montreal Children's Hospital is a healthcare organization based out in Montreal, Quebec, Canada. It is known for research contribution in the topics: Population & Poison control. The organization has 3842 authors who have published 4816 publications receiving 200198 citations.

Stratification of complexity improves the utility and accuracy of outcomes analysis in a Multi-Institutional Congenital Heart Surgery Database: Application of the Risk Adjustment in Congenital Heart Surgery (RACHS-1) and Aristotle Systems in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database.

Abstract: Quality-of-care evaluation must take into account variations in “case mix.” This study reviewed the application of two case-mix complexity-adjustment tools in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database: the Aristotle Basic Complexity (ABC) score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. The 2006 STS Congenital Heart Surgery Database Report, the first STS report to incorporate both methods, included 45,635 operations from 47 centers. Each operation was assigned an ABC score in a range from 1.5 (lowest complexity) to 15 (highest complexity), an ABC level in a range from 1 (lowest complexity) to 4 (highest complexity), and a RACHS-1 category in a range from 1 (lowest risk) to 6 (highest risk). The overall discharge mortality was 3.9% (1,222/31,719 eligible cardiac index operations). Of the eligible cardiac index operations, 85.8% (27,202/31,719) were eligible for analysis by the RACHS-1 method, and 94.0% (29,813/31,719) were eligible for analysis by the ABC approach. With both RACHS-1 and ABC, as complexity increases, discharge mortality also increases. The ABC approach allows classification of more operations, whereas the RACHS-1 discriminates better at the higher end of complexity. Complexity stratification is a useful method for analyzing the impact of case mix on pediatric cardiac surgical outcomes. Both the RACHS-1 and ABC methods facilitate complexity stratification in the STS database.

Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy

Abstract: Object Large-scale natural history studies of gross motor development have shown that children with spastic cerebral palsy (CP) plateau during childhood and actually decline through adolescence Selective dorsal rhizotomy (SDR) is a well-recognized treatment for spastic CP, but little is known about long-term outcomes of this treatment The purpose of this study was to assess the durability of functional outcomes in a large number of patients through adolescence and into early adulthood using standardized assessment tools Methods The authors analyzed long-term follow-up data in children who had been evaluated by a multidisciplinary team preoperatively and at 1, 5, 10, and 15 years after SDR These evaluations included quantitative, standardized assessments of lower-limb tone (Ashworth Scale), Gross Motor Function Measure (GMFM), and performance of activities of daily living (ADLs) by the Pediatric Evaluation of Disability Inventory in children who had been stratified by motor severity using the Gross Mot

Family income and youths' symptoms of depression and anxiety: a longitudinal study of the French GAZEL Youth cohort.

Abstract: Background: It is not clear whether socioeconomic inequalities with regard to depression and anxiety are present in adolescence and young adulthood. We tested the hypothesis that in the community, youths growing up in families with low income have elevated rates of such psychological difficulties. Methods: We used data from participants of the GAZEL Youth study, a French community-based cohort assessed in 1991 and 1999 (n=941 youths, 4–18 years of age at baseline). Measures of family income and youths' symptoms of depression and anxiety (assessed using the ASEBA family of instruments) were obtained from parents and youths at study baseline and follow-up. Covariates included family characteristics (parental divorce, parental unemployment or labor force exit, parental health difficulties including psychopathology and the quality of family relations) and youths' characteristics (sex, age, stressful life events, history of internalizing and externalizing problems). Results: Youths from families with low income during the study period had elevated odds of symptoms of depression and anxiety at follow-up (compared to youths from families with intermediate/high income, age-adjusted OR: 1.74, 95% CI 1.17–2.57; fully adjusted OR: 1.94, 95% CI: 1.27–2.97). In particular, the likelihood of psychological difficulties was elevated among youths from families that experienced decreasing and persistently low income over time (fully adjusted ORs, respectively: 2.44, 95% CI 1.24–4.81 and 1. 83, 95% 1.10–3.06). Conclusions: Clinicians need to be aware that youths growing up in low-income families in the community may be at risk of depression and anxiety during the period of transition to adulthood. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.

Prolonged Inhibition of DNA Synthesis Associated with the Accumulation of Methotrexate Polyglutamates by Cultured Human Cells

Abstract: Incubation of cultured human fibroblasts in 1 µM methotrexate results in a progressive accumulation of poly-γ-glutamyl derivatives. This accumulation is not dependent on new protein synthesis. No polyglutamate derivatives are detectable until saturation by nonmetabolized methotrexate of a nonexchangeable intracellular fraction occurs. After saturation occurs both methotrexate and methotrexate polyglutamates are found in a freely-exchangeable and a non-exchangeable fraction. After saturation occurs all of the increase in the size of the nonexchangeable fraction is due to the accumulation of polyglutamates. Cells which have been incubated for up to 2 hr in 1 µM methotrexate rapidly regain the ability to incorporate deoxyuridine into DNA when transferred into methotrexate-free medium. With longer times of incubation resulting in the formation of longer and greater concentrations of polyglutamates, deoxyuridine incorporation is inhibited at least 24 h following transfer into methotrexate-free medium. In contrast, thymidine incorporation into DNA is increased over that seen in cells not incubated in methotrexate. We suggest that the metabolism of methotrexate in cultured human fibroblasts occurs according to the following steps: (i) saturation by nonmetabolized methotrexate of a nonexchangeable pool, (ii) addition of γ-glutamyl residues to methotrexate in a freely-exchangeable pool, (iii) appearance of methotrexate polyglutamates in a nonexchangeable pool. The inhibition of deoxyuridine incorporation in the absence of continued methotrexate may be due to the effects of previous sustained exposure to methotrexate, to the total quantity of methotrexate derivatives, or to some undefined differential effect of methotrexate polyglutamates.