First name
Blanca
Middle name
E
Last name
Himes

Title

COVID-19 Pandemic-Related Reductions in Pediatric Asthma Exacerbations Corresponded with an Overall Decrease in Respiratory Viral Infections.

Year of Publication

2021

Date Published

2021 Nov 13

ISSN Number

2213-2201

Abstract

<p><strong>BACKGROUND: </strong>Respiratory viruses, air pollutants, and aeroallergens are all implicated in worsening pediatric asthma symptoms, but their relative contributions to asthma exacerbations are poorly understood. A significant decrease in asthma exacerbations has been observed during the COVID-19 pandemic, providing a unique opportunity to study how major asthma triggers correlate with asthma activity.</p>

<p><strong>OBJECTIVE: </strong>To determine whether changes in respiratory viruses, air pollutants, and/or aeroallergens during the COVID-19 pandemic were concomitant with decreased asthma exacerbations.</p>

<p><strong>METHODS: </strong>Health care utilization and respiratory viral testing data between January 1st, 2015 and December 31st, 2020 were extracted from the Children's Hospital of Philadelphia (CHOP) Care Network's electronic health record. Air pollution and allergen data were extracted from U.S. Environmental Protection Agency public databases and a National Allergy Bureau-certified station, respectively. Pandemic data (2020) were compared to historical data.</p>

<p><strong>RESULTS: </strong>Recovery of in-person asthma encounters during phased re-opening (June 6 - November 15, 2020) was uneven: primary care well and specialty encounters reached 94% and 74% of pre-pandemic levels, respectively, while primary care sick and hospital encounters reached 21% and 40% of pre-pandemic levels, respectively. During the pandemic, influenza A and influenza B decreased to negligible frequency when compared to pre-pandemic cases, while RSV and rhinovirus infections decreased to low (though non-negligible) pre-pandemic levels, as well. No changes in air pollution or aeroallergen levels relative to historical observations were noted.</p>

<p><strong>CONCLUSIONS: </strong>Our results suggest that viral respiratory infections are a primary driver of pediatric asthma exacerbations. These findings have broad relevance to both clinical practice and the development of health policies aimed at reducing asthma morbidity.</p>

DOI

10.1016/j.jaip.2021.10.067

Alternate Title

J Allergy Clin Immunol Pract

PMID

34785388

Title

Why Is the Electronic Health Record So Challenging for Research and Clinical Care?

Year of Publication

2021

Date Published

2021 Jul 19

ISSN Number

2511-705X

Abstract

<p><strong>BACKGROUND: </strong> The electronic health record (EHR) has become increasingly ubiquitous. At the same time, health professionals have been turning to this resource for access to data that is needed for the delivery of health care and for clinical research. There is little doubt that the EHR has made both of these functions easier than earlier days when we relied on paper-based clinical records. Coupled with modern database and data warehouse systems, high-speed networks, and the ability to share clinical data with others are large number of challenges that arguably limit the optimal use of the EHR OBJECTIVES:  Our goal was to provide an exhaustive reference for those who use the EHR in clinical and research contexts, but also for health information systems professionals as they design, implement, and maintain EHR systems.</p>

<p><strong>METHODS: </strong> This study includes a panel of 24 biomedical informatics researchers, information technology professionals, and clinicians, all of whom have extensive experience in design, implementation, and maintenance of EHR systems, or in using the EHR as clinicians or researchers. All members of the panel are affiliated with Penn Medicine at the University of Pennsylvania and have experience with a variety of different EHR platforms and systems and how they have evolved over time.</p>

<p><strong>RESULTS: </strong> Each of the authors has shared their knowledge and experience in using the EHR in a suite of 20 short essays, each representing a specific challenge and classified according to a functional hierarchy of interlocking facets such as usability and usefulness, data quality, standards, governance, data integration, clinical care, and clinical research.</p>

<p><strong>CONCLUSION: </strong> We provide here a set of perspectives on the challenges posed by the EHR to clinical and research users.</p>

DOI

10.1055/s-0041-1731784

Alternate Title

Methods Inf Med

PMID

34282602

Title

Pediatric Asthma Healthcare Utilization, Viral Testing, and Air Pollution Changes during the COVID-19 Pandemic.

Year of Publication

2020

Date Published

2020 Aug 17

ISSN Number

2213-2201

Abstract

<p><strong>BACKGROUND: </strong>The COVID-19 pandemic caused dramatic changes in daily routines and healthcare utilization and delivery patterns in the United States. Understanding the influence of these changes and associated public health interventions on asthma care is important to determine effects on patient outcomes and identify measures that will ensure optimal future healthcare delivery.</p>

<p><strong>OBJECTIVE: </strong>We sought to identify changes in pediatric asthma-related healthcare utilization, respiratory viral testing, and air pollution during the COVID-19 pandemic.</p>

<p><strong>METHODS: </strong>For the time period Jan 17-May 17, 2015-2020, asthma-related encounters and weekly summaries of respiratory viral testing data were extracted from Children's Hospital of Philadelphia (CHOP) electronic health records, and pollution data for four criteria air pollutants were extracted from AirNow. Changes in encounter characteristics, viral testing patterns, and air pollution before and after Mar 17, 2020, the date public health interventions to limit viral transmission were enacted in Philadelphia, were assessed and compared to data from 2015-2019 as a historical reference.</p>

<p><strong>RESULTS: </strong>After Mar 17, 2020, in-person asthma encounters decreased by 87% (outpatient) and 84% (emergency + inpatient). Video telemedicine, which was not previously available, became the most highly utilized asthma encounter modality (61% of all visits), and telephone encounters increased by 19%. Concurrently, asthma-related systemic steroid prescriptions and frequency of rhinovirus test positivity decreased, while air pollution levels did not substantially change, compared to historical trends.</p>

<p><strong>CONCLUSION: </strong>The COVID-19 pandemic in Philadelphia was accompanied by changes in pediatric asthma healthcare delivery patterns, including reduced admissions and systemic steroid prescriptions. Reduced rhinovirus infections may have contributed to these patterns.</p>

DOI

10.1016/j.jaip.2020.07.057

Alternate Title

J Allergy Clin Immunol Pract

PMID

32827728

Title

Gene Expression Profiles in Children With Suspected Sepsis.

Year of Publication

2020

Date Published

2020 Jan 23

ISSN Number

1097-6760

Abstract

<p><strong>STUDY OBJECTIVE: </strong>Sepsis recognition is a clinical challenge in children. We aim to determine whether peripheral blood gene expression profiles are associated with pathogen type and sepsis severity in children with suspected sepsis.</p>

<p><strong>METHODS: </strong>This was a prospective pilot observational study in a tertiary pediatric emergency department with a convenience sample of children enrolled. Participants were older than 56 days and younger than 18 years, had suspected sepsis, and had not received broad-spectrum antibiotics in the previous 4 hours. Primary outcome was source pathogen, defined as confirmed bacterial source from sterile body fluid or confirmed viral source. Secondary outcome was sepsis severity, defined as maximum therapy required for shock reversal in the first 3 hospital days. We drew peripheral blood for ribonucleic acid isolation at the sepsis protocol activation, obtained gene expression measures with the GeneChip Human Gene 2.0 ST Array, and conducted differential expression analysis.</p>

<p><strong>RESULTS: </strong>We collected ribonucleic acid samples from a convenience sample of 122 children with suspected sepsis and 12 healthy controls. We compared the 66 children (54%) with confirmed bacterial or viral infection and found 558 differentially expressed genes, many related to interferon signaling or viral immunity. We did not find statistically significant gene expression differences in patients according to sepsis severity.</p>

<p><strong>CONCLUSION: </strong>The study demonstrates feasibility of evaluating gene expression profiling data in children evaluated for sepsis in the pediatric emergency department setting. Our results suggest that gene expression profiling may facilitate identification of source pathogen in children with suspected sepsis, which could ultimately lead to improved tailoring of sepsis treatment and antimicrobial stewardship.</p>

DOI

10.1016/j.annemergmed.2019.09.020

Alternate Title

Ann Emerg Med

PMID

31983492

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