The role of parental health and distress in assessing children's health status.

PURPOSE: The purpose of the study was to examine the contributions of parents' health and distress to parent's and children's assessments of children's health. METHODS: We used baseline data from a longitudinal study of 364 children (ages 4-12) about to undergo surgery and their parents in a Southern California pediatric hospital. We used the 20-item child self-reported CHRIS 2.0 general health and the parallel parent-reported measure of the child's health, along with a measure of parental distress about the child's health were administered in the perioperative period. Other measures included parents' physical and mental health, quality of life, distress over their child's health, and number and extent of other health problems of the child and siblings. RESULTS: On average, parents' reports about the child were consistently and statistically significantly higher than children's self-reports across all sub-dimensions of the CHRIS 2.0 measure. Parents' personal health was positively associated with their reports of the child's health. More distressed parents were closer to the child's self-reports, but reported poorer personal health. CONCLUSION: Parent-child differences in this study of young children's health were related to parental distress. Exploring the nature of the gap between parents and children in assessments of children's health could improve effective clinical management for the child and enhance family-centered pediatric care. Future studies are needed to assess the generalizability of CHRIS 2.0 to other health settings and conditions and to other racial/ethnic groups.

Improving direct pharmacist counseling rates for oral oncolytic medications at an outpatient oncology clinic.

BACKGROUND: Due to the increasing prevalence of oral oncolytic utilization for patients with malignancy, implementation of strategies for increased monitoring and patient safety have become a necessity. Our focus was on the American Society of Clinical Oncology's Quality Oncology Practice Initiative (QOPI) standards of care, standard 2.3, and its requirement for patient counseling prior to first administration of oral oncolytic therapy. OBJECTIVE: To assess the implementation of a workflow improvement strategy to determine its effect on the number of patients reached for pharmacist counseling prior to first dose of oral oncolytic medications. METHODS: In this quasi-experimental quality improvement study, we formed a multidisciplinary group to develop and implement a workflow improvement process. This process was focused on a redistribution of workflow and the implementation of new technology within EPIC Beacon. RESULTS: A total of 86 patients were identified as eligible for counseling (38 pre-intervention, 48 post-intervention). There was a statistically significant increase in number of eligible patients counseled in the post-intervention period as compared to the pre-intervention period (100% vs. 86.84%; 95% CI = -0.212, -0.205; P = 0.017). There were no significant differences observed in the number of patients counseled in-person or patients counseled prior first dose. CONCLUSION: Our intervention showed a 100% rate of counsel in the post-intervention period. Further work needs to be done to improve the number of these patients we reach prior to them taking their first dose of medication, as well as the number of patients we are able to counsel face-to-face.

Development and initial validation of self-report measures of general health, preoperative anxiety, and postoperative pain in young children using computer-administered animation.

BACKGROUND: For young children, existing measures of children's health-related quality of life must be parent-reported or interviewer-administered for those who cannot read or complete measures independently. Parents' and childrens' reports about the child's health have been shown to disagree. AIMS: (a) To test the reliability and validity of an animated, computer-administered Child Health Rating Inventories (CHRIS2.0) among children aged 4-12 undergoing surgery; and (b) to develop and test two CHRIS measures of preoperative anxiety and postoperative pain management. METHODS: We conducted a longitudinal cohort study of a diverse group of 542 children aged 4-12 undergoing surgery. We compared the CHRIS measures to Pediatric Quality of Life Inventory (PedsQL), the Functional Disabilities Inventory (FDI), State-Trait Anxiety Inventory for children (STAI-CH), and the Parent Postoperative Pain Measure (PPPM). RESULTS: Factor analyses supported the construct validity of the 12-item general physical health and the 8-item mental health CHRIS scales, as well as a composite 20-item scale, and the CHRIS preoperative anxiety and postoperative pain scales. Internal consistency reliability for all CHRIS scales exceeded the standard for group comparisons (Cronbach's α ≥0.70). The CHRIS general health composite was significantly correlated with composite PedsQL and FDI (r = 0.28, P < .001 and r = 0.43, P < .001, respectively). The CHRIS peri-operative anxiety measure was significantly correlated with the STAI-CH (r = 0.44, P < .001), as was the CHRIS postoperative pain scale with the PPPM (r = 0.52, P < .001). CONCLUSIONS: The CHRIS measures were reliable and valid in this diverse sample of young children (4-12). Because CHRIS measures are self-administered, scored in real time, and run on multiple different platforms, this approach provides a feasible method for the collection of health-related quality of life in young children and those with limited literacy. Our data indicate that this approach is psychometrically sound and has the potential for adding the child's voice to pediatric outcomes.

Crystal structures of FolM alternative dihydrofolate reductase 1 from Brucella suis and Brucella canis.

Members of the bacterial genus Brucella cause brucellosis, a zoonotic disease that affects both livestock and wildlife. Brucella are category B infectious agents that can be aerosolized for biological warfare. As part of the structural genomics studies at the Seattle Structural Genomics Center for Infectious Disease (SSGCID), FolM alternative dihydrofolate reductases 1 from Brucella suis and Brucella canis were produced and their structures are reported. The enzymes share ∼95% sequence identity but have less than 33% sequence identity to other homologues with known structure. The structures are prototypical NADPH-dependent short-chain reductases that share their highest tertiary-structural similarity with protozoan pteridine reductases, which are being investigated for rational therapeutic development.