Leveraging real-time data to drive quality improvement in a pediatric health system

We are inundated by data;healthcare is no different.The electronic medical record,the numerous patient care monitors,and the thousands of medications to be reconciled with specific dosing parameters are a few examples of the omnipresent and intimidating nature of data in healthcare.Across the world,healthcare without data does not exist.The data represent many forms but are quickly moving towards electronic formats.As ubiquitous as data are the near universal finding that such data are lagging.There is an urgent need for real-time data in improving processes and ultimately outcomes in healthcare.If data lag by four to eight weeks,if not longer,then true change cannot occur and harm continues in that interval.This review article discusses the urgent need for real-time data and demonstrates examples of how Children's National Medical Center in Washington,DC uses real-time data to drive outcomes.

Experimental assessment of a 3-D plenoptic endoscopic imaging system

All endoscopic imaging system using a plenoptic technique to reconstruct 3-D information is demonstrated and analyzed in this Letter. The proposed setup integrates a clinical surgical endoscope with a plenoptic camera to achieve a depth accuracy error of about 1 mm and a precision error of about 2 mm, within a 25 mm×25 mm field of view, operating at 11 frames per second.

2016年美国《IDSA和SHEA“实施抗生素管理项目”指南》第一部分

住院患者(包括长期护理机构在内)抗生素管理干预实施和评估的循证指南由美国感染病协会(The Infectious Disease Society of America[IDSA])和美国医疗保健流行病学协会(The Society of Healthcare Epidemiology of America[SHEA])组织的多学科专家小组编写。该小组包括了众多临床医生和研究人员,专业背景覆盖内科学、急诊医学、微生物学、重症医学、外科学、流行病学、临床药学,以及成人和儿童感染性疾病等。这些推荐意见为抗生素管理项目(Antimicrobial Stewardship Program[ASP])如何影响抗生素的合理化使用提供了最好的策略。

2016年美国《IDSA和SHEA“实施抗生素管理项目”指南》第三部分

住院患者(包括长期护理机构在内)抗生素管理干预实施和评估的循证指南由美国感染病协会(The Infectious Disease Society of America[IDSA])和美国医疗保健流行病学协会(The Society of Healthcare Epidemiology of America[SHEA])组织的多学科专家小组编写。该小组包括了众多临床医生和研究人员,专业背景覆盖内科、急诊医学、微生物学、重症医学、外科学、流行病学、临床药学,以及成人和儿童感染性疾病等。这些推荐意见为抗生素管理项目(Antimicrobial Stewardship Program[ASP])如何影响抗生素的合理化使用提供了最好的策略。

2016年美国《IDSA和SHEA“实施抗生素管理项目”指南》第二部分

住院患者(包括长期护理机构在内)抗生素管理干预实施和评估的循证指南由美国感染病协会(The Infectious Disease Society of America[IDSA])和美国医疗保健流行病学协会(The Society of Healthcare Epidemiology of America[SHEA])组织的多学科专家小组编写。该小组包括了众多临床医生和研究人员,专业背景覆盖内科学、急诊医学、微生物学、重症医学、外科学、流行病学、临床药学,以及成人和儿童感染性疾病等。这些推荐意见为抗生素管理项目(Antimicrobial Stewardship Program[ASP])如何影响抗生素的合理化使用提供了最好的策略。

Genotype-Phenotype Correlations in Ornithine Transcarbamylase Deficiency: A Mutation Update

Ornithine transcarbamylase （OTC） deficiency is an X-linked trait that accounts for nearly half of all inherited disorders of the urea cycle. OTC is one of the enzymes common to both the urea cycle and the bacterial arginine biosynthesis pathway; however, the role of OTC has changed over evolution. For animals with a urea cycle, defects in OTC can trigger hyperammonemic episodes that can lead to brain damage and death. This is the fifth mutation update for human OTC with previous updates reported in 1993, 1995, 2002, and 2006. In the 2006 update, 341 mutations were reported. This current update contains 417 disease-causing mutations, and also is the first report of this series to incorporate information about natural variation of the OTC gene in the general population through examination of publicly available genomic data and examination of phenotype/genotype correlations from patients participating in the Urea Cycle Disorders Consortium Longitudinal Study and the first to evaluate the suitability of systematic computational approaches to predict severity of disease associated with different types of OTC mutations.

Fever of unknown origin:a retrospective review of pediatric patients from an urban,tertiary care center in Washington,DC

Background Fever of unknown origin(FUO)continues to challenge clinicians to determine an etiology and the need for treatment.This study explored the most common etiologies,characteristics,and average cost of hospitalization for FUO in a pediatric population at an urban,tertiary care hospital in Washington,DC.Methods Records from patients admitted to Children's National Health System between September 2008 and April 2014 with an admission ICD-9 code for fever(780.6)were reviewed.The charts of patients 2-18 years of age with no underlying diagnosis and a temperature greater than 38.3℃for 7 days or more at time of hospitalization were included.Final diagnoses,features of admission,and total hospital charges were abstracted.Results 110 patients qualified for this study.The majority of patients(n=42,38.2%)were discharged without a diagnosis.This was followed closely by infection,accounting for 37.2%(n=41)of patients.Rheumatologic disease was next(n=16,14.5%),followed by miscellaneous(n=6,5.4%)and oncologic diagnoses(n=5,4.5%).The average cost of hospitalization was 40,295 US dollars.Conclusions This study aligns with some of the most recent publications which report undiagnosed cases as the most common outcome in patients hospitalized with FUO.Understanding that,often no diagnosis is found may reassure patients,families,and clinicians.The cost associated with hospitalization for FUO may cause clinicians to reconsider inpatient admission for diagnostic work-up of fever,particularly given the evidence demonstrating that many patients are discharged without a diagnosis.

A parent-centered approach to autism diagnosis in early childhood

The prevalence of autism spectrum disorders in the United States is estimated to be approximately 1 in 68 children (though the World Health Organization estimates a global prevalence of just 1 in 160 children) (1 , 2)The average age of the initial diagnosis is estimated to be 4 years of age [ 3 ], though research has shown that signs of autism can be observed by the fi rst birthday, and possibly before (4 , 5)Early identifi cation of autism is vital to prognosis, as studies have consistently shown that children who receive treatment at a younger age have better outcomes (6)Even with the right treatment, however, the degree to which caregivers are invested in the therapeutic process serves as a mediating fac-tor (7)For this reason, an autism-specifi c evaluation should aim not just to provide a diagnosis, as appropriate, but also to allow caregivers to participate in the diagnostic process in a manner that educates and empowers them.

A current render of pediatric otolaryngology in the United States

Introduction Complex pediatric otolaryngology can be generally regarded as a subspecialty within otolaryngology focusing on the care of children with complex diseases of the head and neck and aerodigestive tract, or in some cases more common diseases in this anatomical region in otherwise medically complex children. This concept of the specialty was succinctly articulated by Charles Bluestone in 1995 when he wrote pediatric otolaryngologists treat 'special problems or special children, or both'.1 Increasingly, this care is delivered by multi-disciplinary pediatric health care providers working at highly specialized tertiary care centers for children. This review will briefly cover the historical evolution of the specialty's origins, along with its current state of graduate medical education training and sub-certification efforts.