Friday, May 22, 2015

Reducing Healthcare-Related Risks: Parental Reading, Learning, and Understanding Their Children’s Diagnostic and Therapeutic Plans


By: Kathleen Walsh  MD, MSC
 
      An  article by Stockwell et al. (doi: 10.1542/peds.2014-2152) published this month in Pediatrics shows, unfortunately, that harm to hospitalized children caused by healthcare is all too common.  The study used a Pediatric All-Cause Harm Measurement Tool developed by the authors to identify one in four hospitalized children suffer harm due to the care they receive, and that 45% of these harms are preventable. 
      The prevention of healthcare associated harm begins with a good metric- to understand the size of the problem and measure the impact of improvement strategies.  Most hospitals measure harm to their patients using a combination of surveillance methods used to measure different types of harm, and most are manually gathered rather than automated.  The tool developed and used by Stockwell et al. is a single metric which can automatically gather information on many types of harm from existing electronic data from the medical record.
      Children outside of the hospital also experience harm in their healthcare. A recent study published in Pediatrics (doi: 10.1542/peds.2014-0309) found that, nationally, poison control centers receive a call every eight minutes for a pediatric medication error.  In another study published in Pediatrics (doi: 10.1542/peds.2012-2434), my group found that children with cancer experience injuries due to medication errors at home at rates comparable to hospitalized patients.  To eliminate harm to children caused by healthcare, researchers and clinicians need to broaden their focus to include all settings where healthcare is delivered.
      What can we do to reduce the risk of harm to their children caused by healthcare?  Clinicians and hospitals should get involved in improvement networks. Networks, such as the Children’s Hospitals Solutions for Patient Safety Network, have made great strides in reducing healthcare harm to hospitalized children.  Parents should take an active role in their child’s healthcare.  The Agency for Healthcare Research and Quality web site contains a list of 20 steps parents can take to reduce errors in their child’s care (http://archive.ahrq.gov/consumer/20tipkid.htm).  The document recommends that parents ask all health care workers who contact the child if they have washed their hands.   
     Parents should ask questions about their child’s home medications, including understanding what the medicine is for, side effects, and what time to give the medicine, and what to use to measure the medicine.  Parents, clinicians, and hospitals will need to partner together to eliminate harm to children caused by healthcare. 

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Wednesday, May 20, 2015

Long-Chain Polyunsaturated Fatty Acids Added to Infant Formula: Does It Improve Cognition at 8 Years of Age?


By: Lewis First, MD, MS; Editor-in-Chief       


      Many of us can certainly remember when studies first heralded the importance of supplementing human milk and formula with docosahexanenoic acid (DHA) and arachidonic acid (AA), two long-chain polyunsaturated fatty acids (PUFAs) especially in very low birth weight (VLBW) infants so as to improve their cognitive function.  While studies indicated that there was evidence of improvement in such function in infancy and toddlerhood, you might wonder if the improvement continues into childhood. Well wonder no more.  
     Almaas et al. (doi: 10.1542/peds.2014-4094) share with us the long-term follow-up results of a randomized double-blinded, placebo controlled trial on a cohort of 129 VLBW infants whose human milk was supplemented with high doses of DHA and AA. The cohort was followed over the next 8 years and 98 children underwent a battery of cognitive tests as well as 81 had MRIs.  Do you think the cognitive differences seen early in life persisted into childhood?  If you did, you may be disappointed with the findings reported in that no significant differences were noted in terms of cognitive or neuroanatomic effects 8 years after the trial. 
     Does this surprise you?  Do you need a better understanding of why the results of this study might show no differences when the intent was to demonstrate the benefits cognitively of receiving PUFAs when VLBW infants were being fed so that cognitive gains would persist as these babies got older?  We asked nutritional experts Drs. Maria Makrides and Ronald Kleinman to share their thoughts on this study with an accompanying commentary (doi: 10.1542/peds.2015-0813) that is food for thought and well worth digesting.  Read both the study and commentary and see what we mean.

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Tuesday, May 19, 2015

Two Strategies to Decrease Pertussis Transmission to Infants: Which One Is Preferred?


By: Lewis First, MD, MS; Editor-in-Chief     

     Given the reluctance to vaccinate children on the part of some parents, as well as issues with efficacy of the vaccine requiring boosters to maintain herd immunity, the burden of pertussis remains a global public health issue not just in this country but around the world, especially in young infants who have not yet been vaccinated fully.  To protect infants from pertussis transmission, two strategies have been proposed:  (1) vaccination of pregnant women with protection through passive passage of antibodies to an infant and (2) cocooning whereby parents, caregivers, and other close contacts are vaccinated to indirectly protect infant transmission by keeping the organism out of those in close proximity to the infant.   
     So which strategy is better?  You’ll have to read a special article by Forsyth et al. (doi: 10.1542/peds.2014-3925) who reviews the evidence for both and arrives at the conclusion that vaccination during pregnancy is the preferred way to protect infants with cocooning as the backup plan.  Doctor Mark Sawyer and Doctor Sarah Long offer their own infectious disease expertise in an accompanying commentary (doi: 10.1542/peds.2015-0770) to further stress the import of making sure Tdap is given to every pregnant mother-to-be. 
      Take a shot at reading both the special article and commentary and in turn, don’t forget to tell pregnant mothers in your practice to get their Tdap if they haven’t already.

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