Research Media Watch



1. Modes of Infant Feeding and the Risk of Childhood Asthma: A Prospective Birth Cohort Study.

Klopp A1, Vehling L1, Becker AB1, Subbarao P2, Mandhane PJ3, Turvey SE4, Lefebvre DL5, Sears MR5;CHILD Study Investigators6, Azad MB7. J Pediatr. 2017 Nov;190:192-199.e2. doi: 10.1016/j.jpeds.2017.07.012.

Objective: To determine whether different modes of infant feeding are associated with childhood asthma, including differentiating between direct breastfeeding and expressed breast milk.

Study Design: We studied 3296 children in the Canadian Healthy Infant Longitudinal Development birth cohort. The primary exposure was infant feeding mode at 3 months, reported by mothers and categorized as direct breastfeeding only, breastfeeding with some expressed breast milk, breast milk and formula, or formula only. The primary outcome was asthma at 3 years of age, diagnosed by trained healthcare professionals.

Results: At 3 months of age, the distribution of feeding modes was 27% direct breastfeeding, 32% breastfeeding with some expressed breast milk, 26% breast milk and formula, and 15% formula only. At 3 years of age, 12% of children were diagnosed with possible or probable asthma. Compared with direct breastfeeding, any other mode of infant feeding was associated with an increased risk of asthma. These associations persisted after adjusting for maternal asthma, ethnicity, method of birth, infant sex, gestational age, and daycare attendance (some expressed breast milk: aOR, 1.64, 95% CI, 1.12-2.39; breast milk and formula, aOR, 1.73, 95% CI, 1.17-2.57; formula only: aOR, 2.14, 95% CI, 1.37-3.35). Results were similar after further adjustment for total breastfeeding duration and respiratory infections.

Conclusions: Modes of infant feeding are associated with asthma development. Direct breastfeeding is most protective compared with formula feeding; indirect breast milk confers intermediate protection. Policies that facilitate and promote direct breastfeeding could have impact on the primary prevention of asthma.

Keywords: Asthma; Breastfeeding; Pumped Breast Milk

Comment:

Due to urbanization lots of changes are happening in lifestyle including breast feeding. Top feeding or expressing breast milk with the help of modern device are on rise

Researchers have found that direct feeding is the best way to feed the baby to reduce the risk of asthma. Express breast milk still provides some benefit as compared to infant formula.

It is the need of the hour to encourage all the mothers to direct breast feed the baby as long as possible with exclusive breast feeding till six month of life. Good antenatal care with health education, motivation & preparing the expecting mother for breast feeding along with providing continuous support to lactating mothers hold the key of good health.


2. Case Not Closed: Prescription Errors 12 Years after Computerized Physician Order Entry Implementation.

Kadmon G1, Pinchover M2, Weissbach A3, Kogan Hazan S3, Nahum E3. J Pediatr. 2017 Nov;190:236-240.e2. doi: 10.1016/j.jpeds.2017.08.013.

Objective: To assess the prolonged impact of computerized physician order entry (CPOE) on medication prescription errors in pediatric intensive care patients.

Study Design: This observational study was conducted at a pediatric intensive care unit in which a CPOE (Metavision, iMDsoft, Israel) with a limited clinical decision support system was implemented between 2004 and 2007. Since then, no changes were made to the systems. We analyzed 2500 electronic prescriptions (1250 prescriptions from 2015 and 1250 prescriptions from 2016). Prescription errors were identified by a pediatric intensive care physician and classified as potential adverse drug events, medication prescription errors, or rule violations. Their prevalence was compared with the rate in 2007, reported in a previous study from the same unit. A randomly selected 10% of the prescriptions were also analyzed by the pediatric intensive care unit pharmacist, and the level of agreement was determined.

Results:The rate of prescription errors increased from 1.4% in 2007 to 3.2% in 2015 (P = .03). Following revision of the clinical decision support system tools, prescription errors decreased to 1% in 2016 (P < .0001). The potential adverse drug event rate dropped from 2% in 2015 to 0.7% in 2016 (P = .006), and the medication prescription error rate, from 1% to 0.2% (P = .01). The agreement between the 2 reviewers was excellent (k = 0.96).

Conclusions: The rate of prescription errors may increase with time from implementation of a CPOE. Repeated surveillance of prescription errors is highly advised to plan strategies to reduce them. This approach should be considered in quality improvement of computerized information systems in general.

Keywords: adverse drug event; clinical decision support system; computerized information system; medication error; patient safety

Comment: Use of computers has been increased in all the sector including health sector as well. It has reduced the burden of writing and maintaining the health records. Prescription errors are known to occurs which can be reduce to minimum by repeated surveillance & upgrading the system on regular basis.


3. The Diagnostic Accuracy of Video EEG Without Event Capture

AndrewKnoxM.D., M.S.1RavindraAryaM.D., D.M.2Paul S.HornPh.D.23KatherineHollandM.D., Ph.D.2

Pediatric NeurologyAvailable online 3 November 2017In Press, Accepted Manuscript

Objective: The aim of this study was to quantify the accuracy of 24 hour video EEG (vEEG) for the diagnosis of epilepsy when a patient’s typical paroxysmal event was not captured (no-event vEEG).

Methods: We performed a retrospective chart review of all first-time 24 hour no-event vEEG studies at Cincinnati Children’s Hospital Medical Center. Clinician diagnosis of epilepsy with a minimum of one year follow-up was used as the reference standard to calculate diagnostic accuracy. Sensitivity and specificity of routine EEG (rEEG) and vEEG were compared in patients with both studies, and factors affecting the accuracy of vEEG were explored with a multivariable analysis.

Results: No-event vEEG showed sensitivity of 0.54 (95% CI 0.44 – 0.64) and specificity of 0.88 (95% CI 0.84 – 0.92) respectively, with a diagnostic odds ratio of 7.53 (95% CI 4.45-12.76). The sensitivity of vEEG was statistically superior to that of rEEG, while specificity was comparable. Age emerged as the only factor that affected the diagnostic accuracy of no-event vEEG.

Conclusion: Even in the absence of a typical seizure or spell, video EEG is a useful test for predicting or excluding epilepsy, with diagnostic accuracy that is superior to rEEG and unaffected by the presence of a chronic neurologic condition.

Keywords: Nondiagnostic Video EEG ,Video EEG Utility in Children,Childhood Epilepsy Childhood Paroxysmal Events

Comment: Video EEG is the excellent tool to differentiate the actual episodes are epileptic seizures or not, if not what are they. It also help to diagnose types of epilepsy,if it is focal seizure from where they are arising. Locating the region is essential if epileptic surgery is considered.


4.Using the PRISM Model to Drive Quality Improvement in the Emergency Department

AmiMehtaMD*1Lindsay F.EilersMD*1Adam M.CampbellPhD*†‡Dana W.E.RamirezMD*†‡Sandip A.GodambeMD, PhD*†‡

Clinical Pediatric Emergency Medicine,Volume 18, Issue 2, June 2017, Pages 103-114

Abstract: In recent years, there has been a push to improve and standardize the quality of clinical care delivered. This has led to marked efforts across institutions to invest in quality improvement (QI) as a part of daily practice. “Problem-solving, Root cause analysis, Improvement Science, and Monitoring” (PRISM) is a model used to detail a stepwise approach to QI in a way that can be easily followed, sustained, and eventually integrated into an organization’s learning system. This model is being used to improve the efficiency of our emergency department admissions process. The various tools that are a part of PRISM are discussed in detail here. Frontline team members have been educated about PRISM and are now engaged and leading improvement efforts within our organization. In short, PRISM has provided the common QI language for our transformation toward becoming a leader in patient- and family-centered care.

Keywords : PRISM, Quality improvement, PDSA, Root cause analysis, Admissions, SIPOC

Comment: At present, it is evident that healthcare is not always safe & can lead to poor patient experience and outcomes. It can also lead to financial setback to the care provider.

At the same time, the quality care provided to the patient should be safe, timely, efficient, person centered & equitable. Quality improvement is a formal approach to the analysis of performance & systematic effort to improve it.

The institution has to adopt certain changes in the management of the patient in such a way to sustain and at the same time improve the quality health care.


Issue: October-December 2017 [Volume 6.4]


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