Correlation between an Independent Electronic Health Record &External Ranking of Children’s Hospitals

Introduction: To evaluate the correlation between the presence of an independent EHR (compared to a shared EHR system within an adult hospital system) and an externally-derived third party ranking of children’s hospitals. Methods: Children’s hospitals that ranked in the top fifty of the 2019-2020 US News and World Report (USNWR) were included in the analysis. The mean and median ranking of children’s hospitals with independent versus a shared EHR was evaluated. The 2019-2020 USNWR rankings of the top twenty adult hospitals in the United States were then evaluated. For each children’s hospital with an associated adult hospital that was both ranked, it was noted as to whether the EHR for the children’s hospital was independent or shared and statistical differences in rankings compared. Results: Among the top 50 children’s hospitals included, the median USNWR ranking for hospitals was statistically different with an independent EHR than with a shared EHR (13 vs. 30.0) (p = 0.002). The 21 top ranked adult hospitals were associated with 17 children’s hospitals ranked in the top 50. The median ranking for those with an independent EHR was statistically different for those with independent EHR versus shared EHR (7 vs. 28) (p = 0.002). Conclusion: Children’s hospitals with an independent EHR are associated with higher scores on an independent external ranking of hospital quality compared to those which share an EHR with a partner adult hospital.

Effectiveness of an early operating room start time in managing pediatric trauma

BACKGROUND The timing of operative treatment for pediatric supracondylar humerus fractures(SCHF)and femoral shaft fractures(FSF)remains controversial.Many fractures previously considered to be surgical emergencies,such as SCHF and open fractures,are now commonly being treated the following day.When presented with an urgent fracture overnight needing operative treatment,the on-call surgeon must choose whether to mobilize resources for a late-night case or to add the case to an elective schedule of the following day.AIM To describe the effect of a program allowing an early operating room(OR)start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight.METHODS Starting in October 2017,patients were eligible for the early slot in the OR at the discretion of the surgeon if they were admitted after 21:00 the previous night and before 05:00.We compared demographics and timing of treatment of SCHF and FSF treated one year before and after implementation as well as the survey responses from the surgical team.RESULTS Of the 44 SCHF meeting inclusion criteria,16 received treatment before imple mentation while 28 were treated after.After implementation,the mean wait time for surgery decreased by 4.8 h or 35.4%(13.4 h vs 8.7 h;P=0.001).There were no significant differences in the operative duration,time in the post anesthesia care unit,and wait time for discharge.Survey results demonstrated decreased popularity of the program among nurses and anesthesiologists relative to surgeons.Whereas 57%of the surgeons believed that the program was effective,only 9%of anesthesiologists and 16%of nurses agreed.The program was ultimately discontinued given the dissatisfaction.CONCLUSION Our findings demonstrate significantly reduced wait times for surgery for uncomplicated SCHF presenting overnight while discussing the importance of shared decision-making with the stakeholders.Although the program produced promising results,it also created new conflicts within the OR staff that led to its discontinuation at our institution.Future implementations of such programs should involve stakeholders early in the planning process to better address the needs of the OR staff.

Role of imaging in the evaluation of inflammatory bowel disease: how much is too much?

Inflammatory bowel disease(IBD) is a lifelong condition with waxing and waning disease course that requires reassessment of disease status as well as screening for complications throughout a patient's lifetime. Laboratory testing, endoscopic assessment, and fecal biomarkers are often used in the initial diagnosis and ongoing monitoring of a patient with IBD. Imaging plays an integral role in the diagnosis and evaluation of IBD. Different imaging modalities can be used over the course of a patient's lifetime, from the initial screening and diagnosis of IBD, to determining the extent of intestinal involvement, monitoring for disease activity, and evaluating for complications of uncontrolled IBD. The various imaging modalities available to the provider each have a unique set of risks and benefits when considering cost, radiation exposure, need for anesthesia, and image quality. In this article we review the imaging techniques available for the evaluation of IBD including fluoroscopic small bowel follow-through, computed tomography enterography, magnetic resonance enterography, and transabdominal ultrasound with particular focus on the judicious use of imaging and the risks and benefits of each option. We also review the risks of ionizing radiation, strategies to reduce exposure to ionizing radiation, and current imaging guidelines among pediatric and adult patient with IBD.

The Importance of Both the Technical and Social Domains in Creating a Culture That Accelerates Improvement in Healthcare

Driving improvement in healthcare can be challenging related in part related to the degree of complexity. We break down the aspects of culture needed to accelerate improvement into a technical domain and a social domain. Task processes can be considered an organization’s technical domain. The social processes, how those doing the work interact, can be thought of as the organization’s social domain. The technical domain focuses on the work related to tasks and the social domain on the relationships that make efficient and effective work possible. We argue that work requirements and social relations are inexorably intertwined—each profoundly impacting, reflecting, and even determining the other. In this review, we argue that in order to accelerate healthcare system improvement, focus must be given to processes that take into consideration both on the social and technical domains.

桃蛀果蛾雌雄虫不同发育时期嗅觉基因的表达水平差异

桃蛀果蛾是严重隐蔽危害的蛀果害虫,亟待开发环境友好型防治方法,昆虫行为调控技术被认为是新型绿色的害虫防控手段,明晰嗅觉识别机制是开发行为调控剂的基础。基于桃蛀果蛾触角转录组得到242个嗅觉基因,基于序列比对和近缘物种相似基因的功能背景,选取了13个嗅觉基因,采用RT-qPCR进一步分析其潜在识别功能。结果表明,13个嗅觉基因中有6个基因在雌雄虫不同发育时期的表达水平存在显著差异(P<0.05),推测这6个基因与成虫期嗅觉识别行为相关;根据雌雄成虫初羽化、成熟未交尾和交尾后基因表达水平的差异推测,OBP11可能在识别性信息素和交配行为中发挥重要作用,OR45可能与雌虫识别寄主植物和产卵过程相关,IR5可能与交配和产卵行为相关。以上研究结果为解析桃蛀果蛾嗅觉识别机制奠定了基础,同时也为开发新型昆虫行为调控剂、构建环境友好的害虫治理策略提供了思路。