PHEMS’ Post

There are a lot of data and insights here on pediatric digital medicine that, unsurprisingly, are critical for pediatric clinical trials. Not surprising because clinical trials are health care after all. To highlight a few of the key points within from a clinical trial perspective: "1. Pediatric health requires a hybrid approach" - YES!!! Flexibility is critical, and digital for all or in all situations is not often appropriate. "2. There’s a real need to support pediatric clinicians" - YES!!! We rely heavily on our pediatricians and specialists to conduct clinical trials, but they need support and tools, not to mention introduction to and support for clinical research during training. "3. School is a core site of care" - Exactly. Not all children are in school, but most are, and factoring that in is often overlooked, or not even leveraged, when planning clinical trials. "4. Pediatrics can’t be uncoupled from poverty..." - YES. Social determinants of health have a critical impact on the physical and mental health of children, including access to trials. Trust as well as existing and susceptibility to trauma are factors that are often overlooked too. "5. Pediatric data management requires a nuanced approach" - Directly from the article, and suffice to say that in clinical trials this can become more complicated, especially as children approach age of majority: "When it comes to pediatric health, parents and other caregivers are often highly engaged in care. Most adolescent patient portals have proxy accounts, ... However, as children age, proxy account management grows more complicated. Privacy laws vary .... Proxy permissions are emotionally charged, balancing a patient’s right to privacy and a parent’s right to access their child’s medical records." "6. Life stage transitions should not be overlooked" On so many levels these transitions impact clinical trials, especially for that special AYA (adults - young adult) population, which are so often overlooked or underconsidered. Looking forward to what is coming up next from the Digital Medicine Society (DiMe) on innovation for pediatric patients! #pediatrics #clinicaltrials #decentralizedclinicaltrials #pediatricclinicaltrials

ICYMI over the holiday break, last week Rock Health released a critically important report on investment into pediatric digital medicine... or lack thereof. By the numbers: 👉 Children make up 23% of the US population... 👉 ... but only 10% of national healthcare expenditure 👉 Investment into digital health solutions for pediatric care languishes in the single-digits This is extraordinary data revealing that not only are we failing to leverage digital innovation to care for the most vulnerable patients who need us the most, our children, but there's an entire market that digital innovators have yet to fully explore. The report provides key guidelines for innovators seeking to advance to address pediatric innovation, and in upcoming work the Digital Medicine Society (DiMe) will be hosting a cohort of leaders in this field to build upon these to create a how-to-guide for leveraging the promise of digital innovation to better care for pediatric patients. H/t to Roxana Obregón, Elisabeth Slighton, Adriana Krasniansky, Sari Kaganoff, and Megan Zweig for this important work... and if you haven't already, check out the full report here: https://lnkd.in/eV9KC8Gn And if you're interested in joining us to address these findings, email [email protected] today!

This expert UCB discussion unpacks key learnings from deployments of pediatric digital measurements and the need for its translation into care. https://hubs.la/Q02jlvP60 #clinicalresearch #clinicaltrials #digitalendpoints #digitalbiomarkers

In this cross-sectional study including 39 043 patients, medical advice request messages sent by patients who belong to minoritized racial and ethnic groups were less likely to receive a response from attending physicians and more likely to receive a response from registered nurses, suggesting lower prioritization during triaging. The differences observed were similar among Asian, Black, and Hispanic patients. The findings of this study suggest potential disparities in how health care team resources are allocated across portal messages by patient race and ethnicity; understanding and addressing these disparities will be necessary for improving care equity…

Becker's Healthcare has honored 34 outstanding hospitals and health systems, including Ochsner Health, for their innovative programs. These institutions are paving the way for the future of healthcare by dedicating themselves to research, discovery and groundbreaking initiatives. Ochsner Health is a national leader in cancer care, cardiology, neurosciences, pediatrics and beyond. With three dynamic innovation programs, Ochsner is at the forefront of transforming care: ⭐ InnovationOchsner: A think tank and innovation lab, driving transformative changes in healthcare. ⭐ Ochsner Ventures: Fostering collaborations, investments in emerging companies and developing diversified businesses. ⭐ Ochsner Digital Medicine: Applying technology and data to craft personalized plans for patients with chronic conditions. This recognition reaffirms Ochsner's commitment to pushing the boundaries of healthcare excellence. #OchsnerInnovates #InnovatingHealthcare 🔗: https://lnkd.in/gkwVWiTw

Known for being one of the most comprehensive pediatric institutes, we have Hancong Tang from Nationwide Children's Hospital presenting at this year’s #HDAA2023 Annual Conference at Denver, Colorado. Register by scanning the QR or clicking the registration link in the comment section: Here’s Hancong Tang’s take: "Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. To facilitate targeted ROP screening for premature/underweight newborns in a neonatal ICU, we aim to develop a predictive model for ROP risk based on easily obtained clinical covariates and much more challenging high-resolution physiologic data from bedside monitors and respiratory support devices. We will present our successful data acquisition and preprocessing approaches for the high-resolution data and report on the importance of this data for predicting ROP. The challenges of acquiring bedside monitor data are two-fold. Obvious difficulty results from the high volume, as bedside monitors record data at a frequency greater than one value per second. It takes significant time and computational resources to simply assure that acquired data is complete and reasonable. In addition, our Philips bedside monitor data is stored in four relational tables that are linked through a sequence of keys, requiring three sets of mapping IDs to identify the monitor data corresponding to a target set of newborn hospital encounters. Heterogeneity in respiratory support data is the major obstacle for incorporating them into a predictive model. Oxygen support methods change over time, as does how corresponding data are stored. Longitudinal respiratory support data were classified using variable EPIC flowsheet identifiers over time, which created significant challenges in harmonizing data over the study period. To organize this data for use, we worked with a clinical informaticist and neonatologist to create logic programming that reproducibly identified specific support classes and respiratory device settings that are relevant for each class without the need for manual chart review." We hope to see you this November 6-9 at Denver #HDAA #AnalyticsWithAltitude #DataAnalytics #Analytics #Conference #healthcareanalytics #healthcare #datacatalog #datascience

Further thoughts on catalyst.nejm.org – Emergency Department Crowding: The Canary in the Healthcare System – Kelen et al outlining root causes of “ED Crowding”, a misnomer as it is overcrowding of the entire system. When we look at the origins of “triage”,“casualty” in the UK, we see the delicate dance between the n=1, the entire ED, the hospital system/network and society. This can be looked at from Little’s Law principle of work in process and cycle time. Cycle time is clear for STEMIs (minutes count) but the challenge with >99% of volume is when does the cycle time end? Is it when they leave the ED or when they leave the hospital making space for the next admission? While written from a US perspective, there are lessons to apply. A great concept is “reverse triage”. This requires data/analytics but also requires medicine’s human side. Many studies try to draw causative conclusions from observational data but healthcare workers are humans that thankfully use their humanity to influence decisions. One notable French study by Roussel et al (JAMA Intern Med. 2023;183(12):1378–1385) suggested a 4% absolute increase in mortality but curiously🧐no increase in morbidity in elderly patients who spent a night in the ED vs those admitted. While worrisome these are non-randomized data with humans deciding. In discussing reverse triaging, the NEJM authors propose a path looking at societal greater good starting with the ED’s and the hospital’s ability to manage its current burden. Big data and AI coupled with the human touch ARE part of the solution. The above can only inform us as to how to plan trials to test, rather than just implement changes solely based on imperfect data. Pragmatic trials–one week/month with a flow paradigm, a second week/month with another should be used for a data driven and scientifically sound approach. The authors stayed very macro. Here are some unmentioned operational considerations to help working on both the work in process and cycle time. Point of care (POC)testing in clinics or the home can take patients with lower pre-test probability of needing an ED visit/admission out of the equation. Patients with abnormalities can be on-boarded directly from home/clinic to a hospital@home. Patients in the ED or already hospitalized can avoid/shorten hospitalization using virtual care. Fluid dynamics dictates that even small changes in capacity can lead to exponentially more “flow”. CCOMTL coordinated by our C4 command center has mobilized the entire organization. Our H@H, Recovery@Home programs, our new Homecare-based respiratory virus program (Flu-SWAT) with newly purposed POC testing, our resident evaluation in CHSLDs using Hololens are all great examples of new ways of thinking that will grow and contribute to improvements in “Emergency Crowding”. Lawrence Rosenberg Lucie Tremblay Erin Cook Amina Talib Marc Afilalo Serge Cloutier Shannon Fraser Jennifer Clarke Mary Lattas Andre Poitras Kimberley Gartshore

In these days, the Chiesi Foundation team took part in jENS: The Congress of joint European Neonatal Societies which was held in Rome.   #jENS is the first international neonatal congress where medical societies, scientists, healthcare professionals and parent representatives form a partnership and contribute #equally to the congress programme. The opening ceremony, focused on the problem of #maternal and #neonatal health in the #globalsouth and, more  specifically, on the African context. Among the speakers of the opening ceremony there were also some partners of the Foundation including ANA - African Neonatal Association and NEST360. According to the United Nations Sustainable Development Goals report published in July 2023, a significant reduction in child mortality has been achieved over the past two decades but despite this progress, 5 million children still lost their lives before their fifth birthday in 2021.  2,3 millions are newborn babies. As Chiesi Foundation we believe it’s #essential to involve and sesitize all actors working in maternal and newborn health on the importance of #accelerating and intensifying efforts to reduce neonatal mortality. With this trend 63 countries will not reach the target set by SDG3. How can we do that?  🔷 By giving visibility to data related to neonatal mortality.    🔹 Involving local institutions at all levels to #implement policies to reduce maternal and newborn mortality. 🔷 Increasing investments in both prevention and treatment. 🔹 Giving space to local actors and encouraging multistakeholder partnerships. #Change is possible, but only through joint actions. #healthforall #healthequity #acceleratingchange #newborncare #chiesifoundation