Showing posts with label research. Show all posts
Showing posts with label research. Show all posts

Friday, October 2, 2015

You Asked for It! Implementing the Innovations in Pediatrics You Asked For


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


          One of the highlights of being an editor is hearing from readers on a regular basis, and over the six years since I have been at the helm, it is common for readers to say things like “why can’t the journal give me just what I need rather than have to search each issue for articles that are of relevance to what I do” or “I didn’t even realize the print edition only has half the published articles of each issue.”  We see millions of readers accessing our journal online only versus the thousands of subscribers who get the print version.   
     We also see the incredible advances in online journal technology enabling us to offer multimedia innovations and further speed up how studies are shared with you. For all these reasons and more, beginning this fall and going into 2016, we are changing how we share articles and studies with you—making the journal easier to access for your needs, and at the same time changing what the online and print edition of the journal will contain and look like going forward.  In a commentary written by our senior editorial team (doi: 10.1542/peds.2015-2877), we introduce the “Gateway”—a new platform that will enable you to manage Pediatrics so it works for you uniquely whether you want to peruse an entire issue or just articles that are of important to what you do.  We also alert you to the fact that as of January, the print edition will consist of all one page abstracts for research articles in the journal and all AAP policies with full-text but no longer will full regular articles or other features appear in print.  
      Instead, all full text articles and non-policy features (as well as all policies too) will appear on the online edition of each journal.  This comes as a result of the input from AAP members.  Having an online network for the journal will also enable us to release new studies daily rather than weekly and bring you linkage to all other AAP journals and newsletters you subscribe to.  Please read the commentary, then use the Gateway to access the journal and manage how you want to personalize each issue when the new platform debuts in October. Please send us your feedback through our Contact Us Form.

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Monday, September 21, 2015

Everything You May Not Have Realized You Wanted to Need and Know About Genomic Sequencing

By: Lewis First, MD, MS; Editor-in-Chief         
      
     More and more we are recognizing the benefits and the risks, especially ethical risks of genomic sequencing studies on pediatric patients.  If you have not yet had a patient need genomic sequencing, it is only a matter of time until this technique becomes cost-effective and available to be ordered at the primary care level—maybe not just yet, but it’s coming soon.  To help all pediatricians better understand how to communicate and in turn interpret these tests, given the uncertainty of the data we can now get through sequencing, some assistance is needed.  Fortunately this week we are releasing two articles that we feel are good ones to read and file in your folder of articles to turn to when faced with a family asking or whom you feel needs genomic sequencing.   
     McCullough et al. (doi: 10.1542/peds.2015-0624) offers an ethical backbone to help us disclose results to families who have sequencing performed on their child.  This special article guides us through the process of how to recommend sequencing and then discuss the results and implications using core concepts of medical ethics.  Adding to this article is an accompanying commentary by geneticist Dr. Leah Burke (REF) that provides insight into how sequencing will become more and more integrated into the care we deliver.           
      Read the article and commentary in sequence and you’ll probably find yourself referring back to both as genomic sequencing becomes more and more a part of primary and specialty care practice.

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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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Monday, September 8, 2014

Cancer Trend Data in Children May Surprise You and Your Patients

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by Kathryn Cartwright

When was the last time you looked at cancer trends in children and adolescents? Siegel et al. (doi: 10.1542/ peds.2013-3926), in a study we are releasing this week, opted to analyze data from a national cancer registry containing information on more than 94 percent of the US population to review cancer trends in children aged 0- to 19-years-old from 2001 through 2009.

Researchers studied more than 120,000 cases, and while the overall rate of childhood cancers remained stable over this time period, they identified some interesting trends including increases in thyroid and renal cancers with decreases in germ cell tumors and melanomas.

There are many other interesting findings worth reviewing in this comprehensive description analysis of this large database—so rather than my highlighting what interests me, read the article for yourself and for the patients in your practice who may have or be at risk for a particular malignancy so you can tailor the findings to your own practice needs.

Related Reading:

Wednesday, June 18, 2014

A Pediatric Learning Health System & the Search for an Effective IBD Treatment

By: Lewis First, MD, MS

TNF α, (Public Domain)
Children with inflammatory bowel disease (IBD) are commonly seen by both primary care providers and gastrointestinal specialists but never with high enough numbers to really know if a specific approach to IBD is better than others—that is until the arrival of ImproveCareNow (ICN), a network of practices linked together as a pediatric learning health system, which allows standardized data-gathering across sites at multiple children’s hospitals in real time to best determine methods to improve the quality of outcomes in these chronically ill children, teens, and young adults.

This week, Forrest et al. (doi: 10.1542/peds.2013-4103) share with us the result of how the ICN network can be used for high-quality clinical research by looking at data across 35 pediatric gastrointestinal practices as a sequence of non-randomized trials. The study question was whether anti-TNFα therapy was effective at achieving clinical and steroid-free remission rates when compared to children not getting this treatment. The results involve more than 1,800 of 4,130 patients with Crohn’s disease getting this therapy who were then compared to those not receiving TNFα. The results will bowel (I mean bowl) you over and herald this type of network as a valuable research tool for improvement.

To help further highlight the value of learning health systems like ICN, read the accompanying commentary by Abernethy (doi: 10.1542/peds.2014-1182), which further explores the what learning health systems are, how they are put into practice (or not) and the kinds of research opportunities they present.

Both study and commentary will make your helping families with inflammatory bowel disease far less painful than you might imagine dealing with this illness might be, so read on and learn more!