Assuntos
Saúde da Criança/etnologia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Pediatria , Racismo/etnologia , Determinantes Sociais da Saúde/etnologia , Justiça Social , Negro ou Afro-Americano , Diversidade Cultural , Assistência à Saúde Culturalmente Competente/etnologia , Indicadores Básicos de Saúde , Hispânico ou Latino , Humanos , Racismo/prevenção & controle , Sociedades Médicas , Estados Unidos/epidemiologia , Indígena Americano ou Nativo do AlascaAssuntos
Saúde da Criança/etnologia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Pediatria , Racismo/etnologia , Determinantes Sociais da Saúde/etnologia , Justiça Social , Negro ou Afro-Americano , Diversidade Cultural , Assistência à Saúde Culturalmente Competente/etnologia , Educação Médica , Indicadores Básicos de Saúde , Hispânico ou Latino , Humanos , Pediatria/educação , Racismo/prevenção & controle , Sociedades Médicas , Estados Unidos/epidemiologia , Indígena Americano ou Nativo do AlascaRESUMO
Unprecedented opportunities and daunting difficulties are anticipated in the future of pediatric pulmonary medicine. To address these issues and optimize pediatric pulmonary training, a group of faculty from various institutions met in 2019 and proposed specific, long-term solutions to the emerging problems in the field. Input on these ideas was then solicited more broadly from faculty with relevant expertise and from recent trainees. This proposal is a synthesis of these ideas. Pediatric pulmonology was among the first pediatric specialties to be grounded deliberately in science, requiring its fellows to demonstrate expertise in scientific inquiry (1). In the future, we will need more training in science, not less. Specifically, the scope of scientific inquiry will need to be broader. The proposal outlined below is designed to help optimize the practices of current providers and to prepare the next generation to be leaders in pediatric care in the future. We are optimistic that this can be accomplished. Our broad objectives are (a) to meet the pediatric subspecialty workforce demand by increasing interest and participation in pediatric pulmonary training; (b) to modernize training to ensure that future pediatric pulmonologists will be prepared clinically and scientifically for the future of the field; (c) to train pediatric pulmonologists who will add value in the future of pediatric healthcare, complemented by advanced practice providers and artificial intelligence systems that are well-informed to optimize quality healthcare delivery; and (d) to decrease the cost and improve the quality of care provided to children with respiratory diseases.
Assuntos
Pediatria , Pneumologia , Inteligência Artificial , Criança , Atenção à Saúde , Mão de Obra em Saúde , Humanos , Pediatria/educação , Pneumologia/educaçãoAssuntos
Hipertensão Pulmonar/diagnóstico , Doenças do Prematuro/diagnóstico , Recém-Nascido Prematuro , Monitorização Fisiológica/métodos , Pressão Propulsora Pulmonar/fisiologia , Medição de Risco/métodos , Doença Crônica , Saúde Global , Humanos , Hipertensão Pulmonar/epidemiologia , Recém-Nascido , Doenças do Prematuro/epidemiologia , Morbidade/tendênciasRESUMO
OBJECTIVE: Real-world data (RWD) are increasingly used for pharmacoepidemiology and regulatory innovation. Our objective was to compare adverse drug event (ADE) rates determined from two RWD sources, electronic health records and administrative claims data, among children treated with drugs for pulmonary hypertension. MATERIALS AND METHODS: Textual mentions of medications and signs/symptoms that may represent ADEs were identified in clinical notes using natural language processing. Diagnostic codes for the same signs/symptoms were identified in our electronic data warehouse for the patients with textual evidence of taking pulmonary hypertension-targeted drugs. We compared rates of ADEs identified in clinical notes to those identified from diagnostic code data. In addition, we compared putative ADE rates from clinical notes to those from a healthcare claims dataset from a large, national insurer. RESULTS: Analysis of clinical notes identified up to 7-fold higher ADE rates than those ascertained from diagnostic codes. However, certain ADEs (eg, hearing loss) were more often identified in diagnostic code data. Similar results were found when ADE rates ascertained from clinical notes and national claims data were compared. DISCUSSION: While administrative claims and clinical notes are both increasingly used for RWD-based pharmacovigilance, ADE rates substantially differ depending on data source. CONCLUSION: Pharmacovigilance based on RWD may lead to discrepant results depending on the data source analyzed. Further work is needed to confirm the validity of identified ADEs, to distinguish them from disease effects, and to understand tradeoffs in sensitivity and specificity between data sources.
Assuntos
Current Procedural Terminology , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Registros Eletrônicos de Saúde , Hipertensão Pulmonar/tratamento farmacológico , Processamento de Linguagem Natural , Criança , Pré-Escolar , Feminino , Humanos , Seguro Saúde , Masculino , Farmacovigilância , Análise de Regressão , Estudos RetrospectivosAssuntos
Escolha da Profissão , Proteção da Criança , Internato e Residência/tendências , Pediatria , Médicos/provisão & distribuição , Pesquisa Translacional Biomédica , Mobilidade Ocupacional , Criança , Feminino , Humanos , Masculino , Mentores , Médicas , Garantia da Qualidade dos Cuidados de Saúde , Apoio à Pesquisa como Assunto , Ciência/educação , Estados Unidos , Recursos HumanosRESUMO
OBJECTIVE: To determine the clinical course and outcomes of children born early preterm (EPT, <32 weeks), late preterm (LPT, 32 to 35 weeks), and full term (FT, >or=36 weeks) who were subsequently admitted to the pediatric intensive care unit (PICU) with respiratory illness. STUDY DESIGN: Retrospective chart review of patients <2 years old admitted to a tertiary PICU with respiratory illness. RESULTS: Two hundred seventy-one patients met inclusion criteria: 17.3% were EPT, 12.2% were LPT, and 70.5% were FT. Lower respiratory tract infection was the most common diagnosis (55%) for all groups. Median PICU length of stay was longer for EPT (6.3 days) and LPT infants (7.1 days) compared with FT infants (3.7 days; P < .03 for both comparisons). EPT and LPT infants had longer hospital stays (median, 11.7 and 13.8 days, respectively) compared with FT infants (median, 7.1 days; P < .03 and P = .004, respectively). Median hospital charges were also greater for EPT ($85 151) and LPT ($83 576) groups compared with FT group ($55 122; P < .01 and P < .02, respectively). CONCLUSIONS: EPT and LPT infants comprise a considerable proportion of PICU admissions for respiratory illness and have greater resource utilization than FT infants.
Assuntos
Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/epidemiologia , Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/epidemiologia , Displasia Broncopulmonar/economia , Doença Crônica , Feminino , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Pediátrica , Terapia Intensiva Neonatal , Pneumopatias/economia , Masculino , Análise Multivariada , Infecções por Vírus Respiratório Sincicial/economia , Vírus Sinciciais Respiratórios/metabolismo , Estudos Retrospectivos , Fatores de TempoRESUMO
BACKGROUND: The long-term consequences of inhaled nitric oxide (iNO) use in premature newborns with respiratory failure are unknown. We therefore studied the clinical and economic outcomes to 1 year of corrected age after a randomized controlled trial of prophylactic iNO. METHODS: Premature newborns (gestational age Assuntos
Broncodilatadores/administração & dosagem
, Broncodilatadores/economia
, Doenças do Prematuro/terapia
, Óxido Nítrico/administração & dosagem
, Óxido Nítrico/economia
, Insuficiência Respiratória/terapia
, Administração por Inalação
, Análise Custo-Benefício
, Custos e Análise de Custo
, Deficiências do Desenvolvimento/diagnóstico
, Deficiências do Desenvolvimento/epidemiologia
, Seguimentos
, Humanos
, Lactente
, Recém-Nascido
, Recém-Nascido Prematuro
, Doenças do Prematuro/economia
, Exame Neurológico
, Qualidade de Vida
, Respiração Artificial
, Insuficiência Respiratória/economia
, Insuficiência Respiratória/mortalidade
, Análise de Sobrevida
, Taxa de Sobrevida