Sleep and Technology in Early Childhood.

Research suggests that technology use is associated with poorer sleep outcomes among children less than 6 years of age. These associations are evident regardless of the type of technology studied, although evening exposure may have the greatest impact compared with technology use during other parts of the day. More work is needed, particularly given that technology use is relatively high among young children. Clinicians should assess patients' technology exposure, including before bedtime, to assess whether sleep issues stem from children's technology use. Moreover, clinicians should educate caregivers about the association between technology use and sleep problems among young children.

Impact of COVID-19 on prescribing patterns and treatment selection of disease modifying therapies in multiple sclerosis.

BACKGROUND: Certain classes of multiple sclerosis (MS) disease modifying therapies (DMTs) have been associated with an increased risk of severe COVID-19, resulting in prescribers considering changes in their practice habits during the COVID-19 pandemic. This study assessed for differences in prescribing patterns of DMTs along with the reason(s) for modification of therapy over time. METHODS: A retrospective review of medical records at Johns Hopkins Health System was performed. The timeframe of the study, April 2019 to December 2021, was divided into three subcategories: pre-pandemic (April 2019-March 2020), pre-vaccine availability (April 2020-March 2021), and post-vaccine availability (April 2021-December 2021). Patients were identified through dispense reports from the pharmacy dispensing system, and prescribing report from the health-system electronic health record (EHR). The health-system EHR was also utilized to conduct chart reviews for a subset of patients that had a modification in their therapy during the specified timeframes. The study included adult patients that were prescribed at least one DMT through the Johns Hopkins Pharmacy Services during the study timeframe and those who stayed on their DMT for at least 2 months without tolerability issues. Descriptive statistics were used to compare the prescribing practices during the timeframes with the percentage of prescribing for each type of treatment and to assess the percentage of patients that switched therapies in the different time periods. RESULTS: Based on prescribing report data, 670 patients were prescribed a DMT during the pre-pandemic period with infusion therapies being the most prescribed therapies during this timeframe (38%), followed by oral therapies at 35%. In comparison, a total of 620 patients were prescribed a DMT during pre-vaccine pandemic and the percentage of prescriptions of infusion therapies decreased to 28% (-10%) during this timeframe, whereas oral prescriptions increased to 42% (+7%). These trends continued during the post-vaccine timeframe where infusion therapies decreased to 26% (-12%) and oral therapies increased to 43% (+8%) in reference to the pre-pandemic period. Prescribing patterns of self-injectable therapies remained stable throughout the 3 timeframes. A dispensing report cohort of 500 patients were randomly selected for chart reviews to assess therapy modifications due to COVID-19. The percentage of therapy change due to COVID-19 increased to 45.2% during pre-vaccine period and remained at 38.4% during post-vaccine period when compared to the pre-pandemic reference period. The majority of changes due to COVID-19 were delays in infusion therapies (96% during pre-vaccine, and 94% during post-vaccine), not medication changes. CONCLUSION: Prescribing patterns and therapy modifications of DMTs for MS patients were impacted by COVID-19, with the greatest changes observed for the infusion therapies, including reduction in percentage of infusion prescriptions and delays in infusion therapies. Prescribing patterns of lower efficacy self-injectable therapies (interferon-beta and glatiramer acetate) remained stable. The outcomes of this study provide background for future outcomes-focused research studies in MS.

Comparison of provider satisfaction with specialty pharmacy services in integrated health-system and external practice models: A multisite survey.

PURPOSE: The purpose of this study is to obtain insight into providers' satisfaction with services offered by health-system integrated specialty pharmacies and to determine whether providers' perceptions of services offered under an integrated model differ from perceptions of external specialty pharmacy services. METHODS: A multi-site, cross-sectional, online survey of specialty clinic healthcare providers at 10 academic health systems with integrated specialty pharmacies was conducted. The questionnaire was developed by members of the Vizient Specialty Pharmacy Outcomes and Benchmarking Workgroup and was pretested at 3 pilot sites prior to dissemination. Prescribers of specialty medications within each institution were identified and sent an email invitation to participate in the study that included a link to the anonymous questionnaire. Respondents were asked to rate their agreement with 10 statements regarding quality of services of integrated and external specialty pharmacies on a 5-point scale (1 = strongly disagree, 5 = strongly agree). An analysis to determine differences in providers' overall satisfaction with the integrated and external specialty pharmacy practice models, as well as differences in satisfaction scores for each of the 10 statements, was performed using paired-samples t tests. RESULTS: The mean (SD) score for overall satisfaction with integrated specialty pharmacies was significantly higher than the score for satisfaction with external specialty pharmacies: 4.72 (0.58) vs 2.97 (1.20); 95% confidence interval, 1.64-1.87; P < 0.001. Provider ratings of the integrated specialty pharmacy model were also higher for all 10 items evaluating the quality of services (P < 0.05 for all comparisons). CONCLUSION: The study results confirm that the health-system integrated specialty pharmacy practice model promotes high rates of provider satisfaction with services and perceived benefits.

Sleep and Technology in Early Childhood.

Research suggests that technology use is associated with poorer sleep outcomes among children less than 6 years of age. These associations are evident regardless of the type of technology studied, although evening exposure may have the greatest impact compared with technology use during other parts of the day. More work is needed, particularly given that technology use is relatively high among young children. Clinicians should assess patients' technology exposure, including before bedtime, to assess whether sleep issues stem from children's technology use. Moreover, clinicians should educate caregivers about the association between technology use and sleep problems among young children.

Development and Implementation of Clinical Outcome Measures for Automated Collection Within Specialty Pharmacy Practice.

BACKGROUND: Johns Hopkins Specialty Pharmacy Services recognized the need to identify and develop standardized collection methods for clinical outcome measures (COMs) to demonstrate program quality and value to third-party payers, manufacturers, and internal stakeholders. OBJECTIVE: To define specialty COMs and develop a framework for standardized data collection and reporting. METHODS: COMs for specialty pharmacy disease states (cystic fibrosis; hepatitis C; inflammatory conditions in dermatology, gastroenterology and rheumatology; and multiple sclerosis) were identified through a literature search, collaboration with specialty pharmacists, and committee review. Once identified, these measures were distributed to internal and external stakeholders that included specialty clinic team members, drug manufacturers, and third-party payers for input and validation. A standardized process for discrete documentation and data collection of these measures was implemented using case management software, electronic medical record integration, and informatics support. RESULTS: 28 COMs were identified. The various data sources used to collect the COMs were incorporated into an automated virtual dashboard to allow for regular review and sharing with clinicians, leadership, and other key stakeholders. The virtual dashboard included COMs with data derived from electronic medical records (n = 9), patient-reported outcomes based on responses to pharmacist-delivered questions (n = 11), and pharmacist assessment of outcomes (n = 8). The completed virtual dashboard was further refined to allow for reporting of both population and patient-level outcome results on a quarterly basis. CONCLUSIONS: This project describes methods to standardize documentation, data collection, and reporting of clinical outcomes data for multiple specialty conditions in a health system-integrated specialty pharmacy program. Through literature review and stakeholder consultation, a variety of potential COMs were identified for further evaluation of feasibility and value considering documentation and data collection requirements. Incorporation of COMs into a virtual dashboard will help facilitate the evaluation of program effectiveness, quality improvement planning, and sharing with stakeholders. Additional opportunities exist to further standardize COMs across the pharmacy industry to allow for future benchmarking and standardized evaluation of patient care programs. DISCLOSURES: No funding supported the writing of this article. The authors have no relevant conflicts of interest to disclose. This study was presented as a poster presentation at the APhA Annual Meeting, March 2018, Nashville, TN, and as a platform presentation at the Eastern States Conference, May 2018, Hershey, PA.

Electronic Media Use and Sleep Among Preschoolers: Evidence for Time-Shifted and Less Consolidated Sleep.

This study examined the association between electronic media use and sleep among preschoolers, using a national sample of 402 mothers of 3- to 5-year-olds. Participants completed an online survey assessing preschoolers' electronic media use, bedtime and wake time, sleep time, napping behaviors, and sleep consolidation. Results showed that heavier television use and tablet use, both overall and in the evening, were associated with later bedtimes and later wake times, but not with fewer hours of sleep, providing evidence for a time-shifting process. In addition, heavier daily television use and evening smartphone use were associated with increased daytime napping. Moreover, heavier daily television use, daily and evening smartphone use, and evening tablet use were associated with poorer sleep consolidation, suggesting less mature sleep patterns. These findings indicate that media effects on the timing of sleep and the proportion of sleep that occurs at night are important to consider when assessing the health risks of electronic media on children.

The Relation Between Use of Mobile Electronic Devices and Bedtime Resistance, Sleep Duration, and Daytime Sleepiness Among Preschoolers.

This study investigated the relation between preschoolers' mobile electronic device (MED) use and sleep disturbances. A national sample of 402 predominantly college-educated and Caucasian mothers of 3-5-year-olds completed a survey assessing their preschoolers' MED use, bedtime resistance, sleep duration, and daytime sleepiness. Heavier evening and daily tablet use (and to some extent, smartphone use) were related to sleep disturbances. Other forms of MED use were not consistently related to sleep disturbances. In addition, playing games on MEDs at bedtime was related to compromised sleep duration, although other forms of MED use at bedtime were not related to sleep outcomes. Although the relations between MED use and sleep disturbances were small in size, they were larger than the relations between sleep and other predictors in the models. Continued work should investigate how MED exposure is related to children's cognitive, psychological, emotional, and physiological development, particularly given the popularity and widespread use of these devices.

The role of sleep in the relation between young children's mobile media use and effortful control.

We explored the relations among young children's mobile media use, sleep, and a form of self-regulation, temperamental effortful control (EC), among a national sample of 402 mothers who completed an online survey. We found that the relation between mobile media use and EC was moderated by children's sleep time. Tablet use was negatively related to EC only among children who slept less at night (40% of our sample). However, hand-held game player use was positively related to EC among children who slept longer at night (60% of our sample). In addition, sleep quality was a mediator in the relation between evening tablet use and EC. Evening use related to later bedtimes, more bedtime resistance, and worse sleep duration, and these indicators of poor sleep quality, in turn, predicted weaker EC. Statement of contribution What is already known on this subject? Young children are spending increasing amounts of time with mobile media, such as tablets and hand-held game players. Media exposure is related to children's self-regulation. Media exposure is related to children's sleep quality. What does this study adds? Number of sleep hours moderates the relation between mobile media use and EC among young children. Tablet time is negatively related to EC among young children who get fewer sleep hours. Hand-held game playing is positively related to EC among young children who get greater sleep hours. Sleep quality mediates the relation between evening tablet time and EC among young children.

Parenting and Digital Media.

Understanding the family dynamic surrounding media use is crucial to our understanding of media effects, policy development, and the targeting of individuals and families for interventions to benefit child health and development. The Families, Parenting, and Media Workgroup reviewed the relevant research from the past few decades. We find that child characteristics, the parent-child relationship, parental mediation practices, and parents' own use of media all can influence children's media use, their attitudes regarding media, and the effects of media on children. However, gaps remain. First, more research is needed on best practices of parental mediation for both traditional and new media. Ideally, this research will involve large-scale, longitudinal studies that manage children from infancy to adulthood. Second, we need to better understand the relationship between parent media use and child media use and specifically how media may interfere with or strengthen parent-child relationships. Finally, longitudinal research on how developmental processes and individual child characteristics influence the intersection between media and family life is needed. The majority of children's media use takes place within a wider family dynamic. An understanding of this dynamic is crucial to understanding child media use as a whole.

High hepatitis C cure rates among black and nonblack human immunodeficiency virus-infected adults in an urban center.

Hepatitis C virus (HCV) cure rates have been similar in patients with and without human immunodeficiency virus (HIV) coinfection; however, in the ION-4 study, black patients treated with ledipasvir/sofosbuvir (LDV/SOF) were significantly less likely to achieve cure (90%) compared to nonblack patients (99%). There are limited real-world data on the effectiveness of oral direct-acting antivirals (DAAs) in predominantly minority HIV/HCV coinfected populations. We analyzed HCV treatment outcomes among 255 HCV coinfected patients initiating DAAs between February 2014 and March 2016 in an urban clinic in Baltimore, Maryland. To facilitate adherence, patients received standardized HIV nurse/pharmacist support, which included nurse visits and telephone calls. Median age was 43 years, 88% were black, 73% male, 69% had a history of injection drug use, 45% a history of hazardous alcohol use, and 57% a comorbid psychiatric diagnosis. Median CD4 count was 577 (interquartile range, 397-820) cells/mm3 ; most (97%) were on antiretroviral therapy, had HIV RNA <20 copies/mL (87%), and were infected with HCV genotype 1 (98%). Over 60% had significant fibrosis (Fibrosis-4 Index score 1.45-3.25 [44%] and >3.25 [17%, cirrhosis]) and 30% were HCV treatment experienced. The majority of patients received LDV/SOF with or without ribavirin (91%) and were treated for 12 weeks. Overall, the sustained virological response rate was 97% (95% confidence interval [CI], 93-98) and did not vary by race (black, 96% [95% CI, 93-98]; nonblack, 97%, [95% CI, 83-99]), history of injection drug use, alcohol use, or psychiatric diagnosis. CONCLUSION: HCV treatment was highly effective among HIV-infected patients who received care within an integrated nurse/pharmacist adherence support program. These results suggest that race and psychosocial comorbidity may not be barriers to HCV elimination. (Hepatology 2017;66:1402-1412).

Protective effects of parental monitoring of children's media use: a prospective study.

IMPORTANCE: Children spend more time with electronic media than they do in any other activity, aside from sleep. Many of the negative effects that stem from media exposure may be reduced by parental monitoring of children's media use; however, there lacks a clear understanding of the mechanisms and extent of these protective effects. OBJECTIVE: To determine the prospective effects of parental monitoring of children's media on physical, social, and academic outcomes. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort design. Data were collected by in-home and in-school surveys in 2 communities in Iowa and Minnesota, where 1323 third- (n = 430), fourth- (n = 446), and fifth- (n = 423) grade students participated. A primary caregiver and teachers also provided data about the student. INTERVENTIONS: Participants in the current study were recruited to participate in a social ecological model-based obesity prevention program. MAIN OUTCOMES AND MEASURES: Body mass index, average weekly sleep, school performance, prosocial behavior, and aggressive behavior. RESULTS Structural equation modeling revealed that parental monitoring of children's media influences children's sleep, school performance, and prosocial and aggressive behaviors and that these effects are mediated through total screen time and exposure to media violence. CONCLUSIONS AND RELEVANCE: Parental monitoring of media has protective effects on a wide variety of academic, social, and physical child outcomes. Pediatricians and physicians are uniquely positioned to provide scientifically based recommendations to families; encouraging parents to monitor children's media carefully can have a wide range of health benefits for children.

The relation between television exposure and executive function among preschoolers.

This study investigated the relations between television exposure during the preschool years and the development of executive function (EF). Data were gathered from 107 parents of preschoolers who provided information on children's television viewing, background television exposure, exposure to specific televised content, and the age at which children began watching television. Preschoolers' EF was assessed via one-on-one interviews. We found that several indicators of television exposure were significantly related to EF. These findings suggest that EF may be an important construct for continued research on the effects of media on young children.