December 7, 2018

Association Between Variation in Preoperative Care Before Arterial Switch Operation and Outcomes in Patients With Transposition of the Great Arteries.

The arterial switch operation (ASO) is the gold standard operative correction of neonates with transposition of the great arteries and intact ventricular septum, with excellent operative survival. The associations between patient and surgeon characteristics and outcomes are well understood, but the associations between variation in preoperative care and outcomes are less well studied. Here, Dr. Michael O’Byrne and colleagues explore the association between preoperative care (timing of ASO, preoperative use of balloon atrial septostomy, prostaglandin infusion, mechanical ventilation, and vasoactive agents) and operative outcomes (mortality, length of stay, and cost) was studied with multivariable mixed-effects models.

Recent Advances in Technology and Its Applications to Pediatric Emergency Care.

Advances in technology are continuously transforming medical care, including pediatric emergency medicine. The increasing adoption of point-of-care ultrasound examination can improve timely diagnoses without radiation and aids the performance of common procedures. The recent dramatic increase in electronic health record adoption offers an opportunity for enhanced clinical decision-making support. Simulation training and advances in technologies can provide continued proficiency training despite decreasing opportunities for pediatric procedures and cardiorespiratory resuscitation performance. This article from Dr. Robert Grundmeier and colleagues reviews these and other recent advances in technology that have had the greatest impact on the current practice of pediatric emergency medicine.

Pediatric continuity care intensivist: A randomized controlled trial.

Long-stay critically ill patients in the Pediatric Intensive Care Unit (PICU) may be at risk for inconsistencies in treatment plan, delay in plan progression, and patient/family dissatisfaction with communication. This article from Dr. Chris Feudtner, Dr. Jennifer Walter and colleagues describes the development and evaluation of an intervention designed to improve continuity and communication delivered by continuity PICU attendings.

Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study.

Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection. Researchers from CPCE’s Pediatric Infectious Disease Epidemiology & Antimicrobial Stewardship (IDEAS) team tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections in the pediatric intensive care unit (PICU). Although implementation of a biomarker-based algorithm did not decrease overall antibiotic exposure among all uninfected PICU patients, exposures were reduced in the subset of SIRS episodes where biomarkers were low.

Diagnosis and Management of Pediatric Influenza in the Era of Rapid Diagnostics.

Influenza is a significant cause of childhood morbidity and death; it contributes to up to 16% of hospitalizations for respiratory illnesses worldwide. Novel rapid viral diagnostic tests, including molecular diagnostic tests, have the potential to significantly affect both time to diagnosis and selection of optimal anti-infective therapy. However, little is known about current treatment algorithms used in US hospitals. In this study, for hospitalized children in the United States, Dr. Susan Coffin, Dr. Theoklis Zaoutis and colleagues aimed to define the current approaches to influenza diagnosis and treatment and to explore reasons for their potential variation.

Readmissions after Pediatric Hospitalization for Suicide Ideation and Suicide Attempt.

CPCE’s Dr. Stephanie Doupnik and colleagues conducted a retrospective cohort study of a nationally representative sample of hospitalizations for suicide ideation (SI) or suicide attempt (SA) among 6- to 17-year-olds to determine prevalence, risk factors, and characteristics of 30-day readmissions. They found that readmission rates within 30 days were 8.5% for SI and SA hospitalizations and, among 30-day readmissions, more than one-third occurred within 7 days. The strongest risk factors for readmission were hospitalizations for SI/SA or other indications in the 30 days preceding the indexed SI/SA hospitalization. Quality improvement interventions to reduce unplanned 30-day readmissions among children hospitalized for SI or SA should focus on children with a recent prior hospitalization and should be targeted to the first week following hospital discharge.

Mortality, Resource Utilization And Inpatient Costs Vary Among Pediatric Heart Transplant Indications: A Merged Data Set Analysis From The United Network For Organ Sharing And The Pediatric Health Information Systems (UNOS-PHIS) Databases.

Merging UNOS and PHIS databases have enabled a more granular analysis of pediatric heart transplant outcomes and resource utilization. Here, Dr. Richard Aplenc, Dr. Joseph Rossano and colleagues evaluated whether transplant indication at time of transplantation was associated with mortality, resource utilization and inpatient costs during the first year post-transplant. They concluded that children with congenital heart disease, particularly single ventricle patients, require substantially greater hospital resource utilization and have significantly worse outcomes during the first year after heart transplant compared to other indications. Further work is aimed at identifying modifiable pre-transplant risk factors to improve post-transplant outcomes and reduce resource utilization in this complex population. 

Mothers' Mental Health Care Utilization After Screening for Postpartum Depression at Well Child Visits.

American Academy of Pediatrics recommends postpartum depression (PPD) screening. It is unknown if pediatricians are effective in linking mothers to mental health services. The objectives of this study from Dr. James Guevara and colleagues at PolicyLab are to determine: 1) mental health care utilization among women with Medicaid insurance after a positive PPD screen and 2) maternal and infant factors that predict the likelihood of mental health care utilization.

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ACOG Women's Health Policy Research Award (due December 15)

The American Congress of Obstetricians and Gynecologists is accepting applications for the 2015 Warren H. Pearse Women's Health Policy Research Award. The annual program includes a single grant of $10,000 for research that explores an aspect of healthcare policy that assists, defines, or restricts the ability of a physician to deliver health care to women in either the general population or a specific area. Applicants must be a junior fellow or fellow of the college at the time of application.

OnPAR Program for Unfunded NIH Proposals

Last year, the NIH received approximately $30 billion in federal support. In spite of this amount, about 42,500 grants were not funded. To address these unfunded proposals, the NIH has a new Pilot Program that is designed to match researchers with nonprofit disease Foundations or with investments from private companies. Through a new collaboration between the NIH and the private contractor Leidos, researchers can now upload their unfunded NIH Proposals into an online portal at the Online Partnership to Accelerate Research (OnPAR). Foundations and other potential funders can review the NIH scores, and decide whether they might be interested in funding the Projects. Currently, this Pilot Program allows researchers with priority scores better than the 30th percentile to submit their abstracts. Interested Foundations might ask that a researcher send their full NIH Application along with its scores. The consensus opinion is that there are a lot of worthy grants being submitted to the NIH, but there is only so much funding available. OnPAR is one way of trying to match researchers with private Foundations.