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Billions of dollars have been invested in Health Information Technologies (HITs), and randomized controlled trials (RCTs) have been conducted to identify the effects of these interventions. Our objective was to identify the types of outcomes that were measured and reported in these RCTs. We completed a systematic review (Medline, EMBASE, and CENTRAL databases) of RCTs involving children (<18 years) and utilizing HIT interventions. We identified 45 RCTs involving 323,945 children. Most studies reported process outcomes (n = 40/45 (88.9%)) but did not include patient-focused outcomes such as patient/carer functioning (n = 12/45 (26.7%)), clinical/physiological health (n = 10/45, 22.2%), quality of life (n = 3/45, 6.7%), or mortality (n = 1/45, 2.2%). Only 3 of 45 (6.7%) studies reported an evaluation of adverse events. In only 14 of 45 (31.1%) studies was it clear that all outcomes that were measured were reported. It is difficult to use RCTs to fully evaluate the benefits and risks of using HIT interventions in pediatric health care settings because patient-focused outcomes and adverse events are rarely reported. Measures to improve the quality of future trials may include the publication of study protocols and the development of an outcome reporting framework or core outcome set.

Abstract Objectives The objective of this evaluation was to assess the feasibility of implementing a fully integrated, automated, electronic patient-reported outcome measures (ePROM) system into a hospital electronic patient record (EPR; hospital-based clinical record). Additional objectives included evaluating the effect of the system on patient-reported outcome measures (PROM) completion rates and investigating the acceptability of the ePROM. Methods The evaluation was conducted in a rheumatology clinic in a specialist children’s hospital in the UK. Paper-based childhood HAQ PROMs were already used in the clinic, and an EPR was the main hospital information system. The technical feasibility of introducing the ePROM technology was assessed using a case study approach; the effect of the system on PROM completion rates was investigated using a before–after design; and acceptability was assessed using semi-structured questionnaires and a focus group. Results An automated and integrated ePROM system was implemented successfully in April 2021. After implementation, ∼500 automated SMS text messaging invitations to complete ePROMs were sent to care-givers each month. PROM completion rates increased from 33 of 100 (33%) to 47 of 65 (72%) after the introduction of the ePROM system (χ2 = 11.51; P < 0.05). The ePROM system was highly acceptable to patients and clinical staff. Some clinical staff expressed a concern that an electronic system might represent a barrier to care for families with more limited resources. Conclusion High levels of automation and integration with existing technology systems seemed to be key contextual factors associated with the successful implementation and adoption of the ePROM intervention in a paediatric rheumatology clinic. Lay Summary What does this mean for patients? We conducted this study to find out whether it would be practical to use an electronic version of a health questionnaire to collect information about young people’s symptoms and well-being ahead of planned, hospital rheumatology clinics. The aim was to send and upload the completed questionnaires into the patients’ electronic health records using a new automated system. We wanted to find out whether this would increase the frequency with which the questionnaire information was recorded in the health records and to understand whether patients and health-care professionals would find the electronic system acceptable to use. The system was set up successfully and increased the frequency with which the questionnaire results were recorded in patients’ health records from 33% to 72%. The study also identified that patients, their families and health-care professionals generally found the system easy to access and to use. Overall, we think this study highlights that there is potential to use systems like this to improve the quality of information that hospital systems can collect from their patients. This can lead to better understanding of symptoms, contributing to the best possible care.

BackgroundQuinolone antibiotics have a broad spectrum of activity including against Gram-negative organisms (especially Pseudomonas), but their use has been associated with the development of seizures. Our objective was to evaluate the association between the administration of quinolones and seizures for three groups of children: those with epilepsy; those with other CNS disorders; and those without any CNS disorder.MethodWe conducted a systematic review of the MEDLINE, EMBASE and CENTRAL databases. Any studies reporting the administration of quinolones to children and including a methodology for identifying or reporting adverse events were identified by two authors who worked independently. Data relating to study characteristics (including population, intervention, comparison and outcome data) and study quality (including the quality of adverse event reporting) were extracted.ResultsWe identified 140 studies involving 21 884 children. No studies reported involving children with epilepsy and 21 studies reported the involvement of 317 children with CNS disorders. 2/317 (0.63%) children with CNS disorders developed seizures and at least 4/21 567 (0.023%) children without CNS pathology were reported to have developed seizures. The quality of adverse event reporting in included studies was low. Only 8/140 (5.71%) included studies provided details of a methodology for actively identifying adverse neurological events.DiscussionEven for children with CNS disorders the risk of developing seizures in association with the use of quinolones seems to be low. Further evaluations of quinolone use in children should include methodologies for actively identifying and reporting adverse neurological events.

We report a case of a 9-year-old boy who developed hypokalaemic periodic paralysis (HypoPP) following a prodrome of persistent fatigue and muscle aches associated with mildly elevated creatine kinase (CK) levels.HypoPP is usually associated with a sudden onset of weakness and hypokalaemia at presentation. A review of published cases failed to identify any other reports of individuals with a similar onset of symptoms and elevated CK levels prior to the development of frank HypoPP.In the case described above, the association of these symptoms with elevated levels of CK may have been related to the underlying mutation in the skeletal muscle calcium channels that was subsequently identified.In cases of persisting fatigue and myalgia associated with elevated CK levels it may be helpful to consider HypoPP in the differential diagnosis.

ObjectivesExacerbations of asthma and viral induced wheeze are leading causes of morbidity and hospital admission in children and young people. Salbutamol is a mainstay of treatment for these conditions, however there is limited evidence to inform the optimal salbutamol dosing regimen at discharge.1 2 We aimed to investigate the effect of updated salbutamol discharge dosing guidance (1000 microgram 4 hourly) versus the previously followed guidance of 500 microgram 4 hourly in a specialist children’s hospital.MethodsData from the hospital’s electronic patient record was used to identify inpatients with diagnoses of asthma or viral wheeze treated in the year before and two years after the dosing guidance was updated in November 2020. Data from 491 patient records (227 pre-update, 264 post-update) was analysed for salbutamol discharge doses, readmission rates and length of stay.ResultsFollowing the change in guidance, the proportion of patients discharged on 10 puffs of salbutamol 4 hourly, increased significantly from 6.2% to 49.2% (Mann Whitney U value 17057, p <0.05).The seven-day readmission rate increased from 0.0% (n = 0/227) to 2.7% (n = 7/264) (Fisher’s exact test value 0.0168, p <0.05). However, the readmission rates were not significantly different between the cohort of children who were discharged on five puffs of salbutamol (n = 4/134, 3.0%) compared to the group discharged on ten puffs (n = 3/130, 2.3%) (Chi-square statistic = 0.1173, p = 0.739).There was a non-statistically significant reduction in median length of stay between the two periods (27 hours vs. 23 hours (Mann-Whitney U-value = 17177.5, p = 0.9676)).(See table 1)There were no reported clinical incidents associated with the use of salbutamol on discharge.ConclusionDischarging patients on ten puffs of salbutamol proved to be feasible, was associated with a trend towards a reduced length of stay and was not associated with any adverse events. Although there was an increased readmission rate in the period following the change in the dosing guidance, this did not seem to be related to the discharge dose of salbutamol.We conclude that the key factor in guiding patient discharge is the ability to remain clinically stable in the four-hour interval in between the doses of salbutamol rather than the dose of salbutamol itself. Further research, ideally using high-quality prospective study designs, is required to confirm these findings so that clinicians can make evidence-based decisions.Abstract 7771 Table 1[Image Omitted. See PDF.]ReferencesAndrzejowski P, Carroll W. Salbutamol in paediatrics: pharmacology, prescribing and controversies. Archives of Disease in Childhood-Education and Practice 2016 Aug 1;101(4):194–7.Babl FE, Sheriff N, Borland M, Acworth J, Neutze J, Krieser D, Ngo P, Schutz J, Thomson F, Cotterell E, Jamison S. Paediatric acute asthma management in Australia and New Zealand: practice patterns in the context of clinical practice guidelines. Archives of disease in childhood 2008 Apr 1;93(4):307–12.

ObjectiveManagement of wheezy children admitted with viral induced wheeze and asthma involves frequent clinician reviews to wean treatment with salbutamol inhalers. We proposed that a nurse led salbutamol weaning training package would enable the assessment of patients by experienced nurses and would facilitate more timely reviews of wheezy children. Our objective was to assess the feasibility and acceptability of implementing the training package and to explore the nurses’ perceptions of its effects on their confidence to review and wean salbutamol treatment.MethodAfter a literature review and multi-professional consultation, we created a teaching package for eligible nurses working on a general paediatric ward and defined eligibility criteria for patients (see table 1 for patient eligibility criteria). The training package included a pre-recorded educational video, face-to-face clinical examination training and supervised clinical patient reviews with a standardised competency sign off procedure.Nursing staff who participated in the training programme were asked to complete anonymous questionnaires designed to measure the impact of the training on their confidence levels and practice when managing wheezy children.ResultsThe training package was completed by 12 out of the 21 (57%) eligible nurses working on the general paediatric ward.All of the nurses who completed the training(100%) responded to the questionnaire.Before the training only 1/12 (8.3%)nurse felt either extremely or somewhat confident to assess a wheezy child’s salbutamol requirements. After training 12/12 (100%) nurses reported feeling either extremely or somewhat confident. (Graph 2 shows nurses’ confidence before and after training).There was a statistically significant increase in self-reported confidence levels following completion of the training.(Fisher exact test statistic < 0.01)All (100% )nurses surveyed reported a perception that the introduction of the training package would improve patient care and patient/parent/carer confidence in nursing staff’s ability to assess their need for salbutamol. 92% of nurses surveyed found the training beneficial and 67% felt the training had positively impacted on their other nursing practices. Time constraint was identified as potential barrier to implementation of practiceConclusionImplementing a ward-based training package to improve nurses’ confidence to assess and wean salbutamol treatment in wheezy children proved to be feasible and acceptable. Further evaluation objectives include monitoring the effects of the training intervention on key outcomes including length of stay and readmission rates.Abstract 287 Table 1[Image Omitted. See PDF.]

ObjectivesThere is a strong association between poverty and adverse childhood health outcomes.1 To help reduce the impacts of poverty and improve access to health promotion resources, we conducted a service evaluation with three key objectives:Identify the impacts of health inequalities and poverty on family experiences of accessing inpatient healthcareEvaluate whether wider-determinants of children’s health outcomes were assessed by healthcare providers (HCPs) during hospital admissionsExplore HCPs understanding and confidence in addressing the wider-determinants that contribute to disparities in health outcomesMethodsHCPs and parents/carer-givers of children admitted to a general paediatric ward in a specialist children’s hospital located in an area of high social deprivation were invited to complete semi-structured questionnaires. The questionnaire items were designed following a literature review and consultation with the RCPCH Inequalities Toolkit. Quantitative survey data were analysed using descriptive statistical methods and free-text responses were analysed using thematic analysis. The findings from the survey were used to develop educational and health promotion resources.Results50 parents/care-givers and 56 HCPs (including consultants, junior doctors, nurses and health care assistants) completed the questionnaires. Over one-third of parents/care-givers reported negative financial impacts associated with their child’s hospital admission. These included loss of income due to days off work (54%) and cost of food (62%), travel (16%) and parking (32%). Nearly two fifths of parents/care-givers reported skipping meals during their child’s admission due to these impacts. 76% of parents/care-givers reported that they were not offered help with costs, for example car parking costs, during the admission. However, many wanted to be offered advice and support (graph 1). Whilst HCPs were generally confident discussing health promotion topics, most were not confident discussing wider determinants of health (table 1). An overwhelming majority (96%) were in favour of receiving more training. Interventions designed to address the key findings from the surveys included lecture-based teaching to introduce social determinants of health inequalities and advise on health promotion methods, and health promotion resources, including referral links to Citizen’s Advice on prescription and local food banks, were collated on a hospital website. Information boards on the ward were updated with health promotion and health inequalities support, for example advertising free parking and food vouchers.ConclusionA wide spectrum of financial and social factors impact families and children during hospital stays. However, HCPs lack confidence in addressing the socioeconomic needs of patients and their families, and welcomed further training.ReferenceAdjei NK, et al. Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study 2022.Abstract 321 Figure 1[Image Omitted. See PDF.]

Health Information Technologies (HITs) are computing systems used to manage healthrelated data. They are increasingly used in healthcare systems but they are often expensive to implement and they may have negative as well as positive effects on health outcomes.This research was undertaken during the completion of a HIT implementation programme funded by the National Health Service (NHS), in a specialist children’s hospital in England. The aim of the research was to investigate the feasibility of using evidence-based evaluation methods to support decision making processes during the programme.Systematic review methods were used to investigate the effects on clinical pathways supported by HITs. The pathways utilised a range of technologies and were generally reported to have beneficial effects. However, the methods that were used to conduct the evaluations reduced the certainty with which their results could be interpreted, and it was not clear that the most important outcomes had been measured. The findings from this review were used to support the development and implementation of digitised clinical pathways during the course of the programme and to guide the design of an investigation into outcome reporting practices in HIT studies.A focussed systematic review subsequently identified that in randomised trials of paediatric HITs, patient-focussed outcomes were often not measured, and it was not clear that all the outcomes that were measured in the studies were reported. These findings highlighted that current outcome reporting practices may limit the usefulness of paediatric HIT evaluations to decision makers.A systematic review of recommendations included in HIT evaluation frameworks demonstrated a lack of consensus regarding the best methods for evaluating HIT interventions. However, the results also illustrated useful approaches for improving the methods that can be used to plan HIT evaluations and for reporting key aspects of these studies, including participant, setting and intervention characteristics.The findings from these reviews were used to support the planning and conduct of an evaluation of paediatric dose range checking software that was implemented during the programme. The prescription overdosing error rate did not change significantly following the introduction of the software, however there was a significant trend towards a reduction in the severity of harm associated with reported overdosing incidents in the hospital. Conducting the evaluation helped to demonstrate the feasibility of using evidence-based approaches to improve the quality of minimally resource-intensive HIT studies.Findings from this research highlighted the range of factors that need to be carefully considered when HIT evaluations are appraised by decision makers. These factors include: consideration of whether evaluation designs adequately support the relevant decision making objectives; whether participant, setting and intervention characteristics are appropriately reported; and whether HIT specific conflict of interest issues have been considered. To address these issues, a set of appraisal recommendations and a HIT evaluation appraisal checklist have been developed.Recommendations for future research into HIT evaluation methods include consultation with the individuals who use health services and who make decisions about selecting and implementing technologies within health systems. Understanding the information requirements of these key decision makers will help to improve the quality and relevance of HIT evaluations.