Effects of the electronic health record on job satisfaction of academic pediatric faculty.

OBJECTIVE(S): To evaluate the association of Electronic Health Record (EHR) skills and available support with job satisfaction for pediatric faculty at an academic institution. To identify key opportunities for improvement. STUDY DESIGN: Cross-sectional study of pediatric academic faculty physicians using a REDCap survey to inquire about faculty EHR skills, support services, and associations between EHR workflow and job satisfaction. Results were analyzed using bivariate testing. RESULTS: The majority of respondents (n = 127, response rate 37%), rated the effect of EHR workflow on job satisfaction as neutral (36%) or negative (44%). Users with more EHR skills were more likely to indicate a positive effect of the EHR on overall job satisfaction (p = 0.019). 7% of respondents had none of the EHR skills queried and few felt that initial training (35%) or the Information Technology department (26%) were useful in acquiring skills. Two similar divisions, one with three and one without Physician Builders (providers with specialized training in EHR personalization), had statistically significant different EHR satisfaction ratings (p = 0.0012). CONCLUSIONS: Most faculty indicated a negative/neutral effect of the EHR on their overall job satisfaction. Users who indicated more EHR skills had a higher satisfaction rating. Existing training and support were not helpful to users. The division with the most Physician Builders ranked highest in satisfaction. We speculate that 1) adding EHR skills could increase overall job satisfaction and 2) adding Physician Builder resources could increase skills and satisfaction.

Clinical utility of the ECLECTIC framework in providing culturally-informed autism spectrum disorder evaluations: A pediatric case-based approach.

Objective: Social cognition does not exist within a vacuum. One's culture and surrounding social environment influence 1) development of social skills and behaviors, and 2) society's expectations regarding "normal" behavior versus behaviors consistent with the diagnosis of Autism Spectrum Disorder (ASD). Use of a comprehensive cultural framework such as Fujii's ECLECTIC model undergirds valid ASD testing by enhancing clinician awareness of potential biases during clinical decision-making and by supporting culturally relevant recommendations. Method: Four diverse pediatric patients presenting for concerns of ASD are described. Neuropsychological test data and salient cultural considerations are presented within the ECLECTIC framework. Results: The cases illustrate relevant cultural factors critical to the ASD assessment for youth with wide diversity (Southeast Asian, Deaf, Black, Hispanic/Latinx, and Chinese cultures) and varied contextual factors (adoption, underlying Down syndrome). The ECLETIC model better allows integration of salient factors such as cognition, family dynamics, behaviors, educational services, and language dominance. Conclusions: Unrecognized ethnocentric biases may shadow the complexities and nuances involved in ASD assessment across cultures. Such errors are minimized using a comprehensive cultural framework to guide equitable neuropsychological services. The ECLECTIC model's emphasis on cultural and contextual factors results in more accurate findings and more individualized planning for the patient. Recommendations for clinical application are provided.

A Brief Survey of Medical Practitioner Knowledge and Attitudes Regarding Autism Spectrum Disorder in Bahir Dar, Ethiopia.

BACKGROUND: Autism spectrum disorder (ASD) continues to climb in prevalence worldwide. Developed nations have focused on aligning their medical and research communities in order to investigate the mechanisms of pathogenesis, diagnosis, and societal impact of this disorder. A simultaneous rise of ASD has impacted developing nations, such as Ethiopia, without a commensurate ability to research the knowledge, beliefs, resources, and training regarding this condition in the country. MATERIALS AND METHODS: We administered a brief survey during a medical conference in Bahir Dar, Ethiopia, to investigate some of the education, information, and experiences with ASD within a small sample of medical and mental health providers in Ethiopia. RESULTS: The data provided insight into the following areas pertaining to ASD in Ethiopia: perceived causes, knowledge, training, and areas of need. CONCLUSIONS: Understanding local beliefs for causes and cures, as well as gaining indigenous opinions regarding what is needed for ASD education and resources in their nation, is the first step towards understanding the impact of this disorder and the approach to its treatment in Ethiopia.

A population-based study of parkinsonism in an Amish community.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disorder with unknown cause. Genetic mutations account for a minority of cases but the role of environmental factors is unclear. METHODS: We performed a population-based screening for PD in subjects in an Amish community over age 60. PD was diagnosed using standard clinical criteria and the Unified Parkinson Disease Rating Scale motor subsection 3 (UPDRS3). Community prevalence was calculated. We constructed a community pedigree and calculated kinship coefficients, a measure of relatedness between 2 subjects, for every pair of subjects in diagnostic categories: clinically definite PD, UPDRS3 score >9, Mini-Mental State Exam (MMSE) score <25, and normal. RESULTS: Of 262 eligible subjects, 213 agreed to participate, 15 had PD, 43 had MMSE <25, 73 had UPDRS3 >9. The prevalence of PD was 5,703/100,000 with increasing prevalence in every decade of age. Excluding first-degree relatives, normal subjects were more related to each other (0.0102, SD = 0.0266) than subjects with clinically definite PD (0.0054, SD = 0.0100; p = 0.00003), subjects with UPDRS >9 (0.0076, SD = 0.0155; p = 0.00001), and subjects with MMSE <25 (0.0090, SD = 0.0180; p = 0.00003). CONCLUSIONS: PD and parkinsonian signs are common in this population and the prevalence increases with age. The finding that subjects with PD were not more related than normal subjects suggests that environmental factors may contribute to the parkinsonian phenotype in this community.

Efficacy and tolerability of pregabalin in essential tremor: a randomized, double-blind, placebo-controlled, crossover trial.

We performed a double-blind, crossover-design study to assess the tolerability and efficacy of pregabalin (PGB) in patients with essential tremor (ET). Twenty patients (11 women; mean age of 62.2+/-12.7 years, mean ET duration of 25.5+/-14.9 years) with ET were randomized for treatment with PGB (150-600 mg/day) or placebo, titrated over 6 weeks. Identical assessments of the Fahn-Tolosa-Marin Tremor Rating Scale (TRS) (primary endpoint), Clinical Global Impression of Change (CGI-C), Quality of Life in Essential Tremor Questionnaire (QUEST), Hamilton Anxiety Scale (HAM-A), and a sleep hygiene questionnaire (HD-16) were made at the baseline, at the end of treatment periods for both drug and placebo, and following the 2-week washout period preceding crossover. We found no improvement in any of the TRS measures and a statistically significant worsening of QUEST scores while patients were taking PGB. Adverse events were similar in frequency to previously published studies of PGB, the most common being drowsiness and dizziness.

High dose botulinum toxin A for the treatment of lower extremity hypertonicity in children with cerebral palsy.

The aim of this study was to determine the safety profile of high dose (15-25 units/kg) of botulinum toxin A (BTX-A) in children with cerebral palsy (CP) and increased lower extremity muscle tone. We performed a retrospective review of 929 patient encounters at the Movement Disorders Center at Washington University. A total of 261 patients (105 females; 156 males) were treated during these visits, ages 6 months to 21 years (mean 8 y 4 mo [SD 4 y 8 mo]). Ambulatory ability at the time of BTX-A injection was independent ambulation (36.4%, n=95), ambulation with a walker (27.6%, n=72), and non-ambulatory (31.8%, n=83). A few patients (4.2%, n=11) were able to ambulate with a cane or crutch at the time of injection. Participants were characterized according to BTX-A dose, CP etiology, motor involvement pattern, muscles injected, ambulatory ability, and use of oral tone medications. Follow-up records were searched for reported adverse events (AEs), with a mean time to AE assessment of 6.5 weeks (SD 3.38). The AE occurrence was determined for doses of 0 to 4.9 units/kg, 5 to 9.9 units/kg, 10 to 14.9 units/kg, 15 to 19.9 units/kg, and 20 to 25 units/kg. The overall AE occurrence was 4.2%. Standard doses of BTX-A had side-effect occurrences of 3.9% for 5 to 10 units/kg and 7.6% for 10 to 15 units/kg. Among higher doses (15-20 units/kg and 20-25 units/kg) the AE occurrence was 3.5% and 8.6% respectively. No patient developed botulism. AEs were randomly distributed across dosing groups, CP etiologies, clinical phenotypes, ambulatory status, and treatment duration. All doses were associated with a significant increase in passive range of motion using the Tardieu scale. We conclude that higher dose BTX-A is safe in children with a spectrum of CP phenotypes and are well tolerated over time.