Feasibility of establishing a multi-center research database using the electronic health record: The PURSUIT network.

BACKGROUND: Although multi-center research is needed in pediatric urology, collaboration is impeded by differences in physician documentation and research resources. Electronic health record (EHR) tools offer a promising avenue to overcome these barriers. OBJECTIVE: To assess the accuracy, completeness, and utilization of structured data elements across multiple practices. STUDY DESIGN: A standardized template was developed and implemented at five academic pediatric urology practices to document clinic visits for patients with congenital hydronephrosis and/or vesicoureteral reflux. Data from standardized elements in the template and from pre-existing EHR fields were extracted into a secure database. A 20% random sample of infants with data from structured elements from 1/1/2020 and 4/30/2021 were identified and compared to manual chart review at sites with >100 charts; all other sites reviewed at least 20 charts. Manual chart review was standardized across sites and included: clinic and operative notes, orders linked to the clinic encounter, radiology results, and active medications. Accuracy of data extraction was evaluated by computing the kappa statistic and percentage agreement. For sites that had adopted the templates prior to 6/1/2019 (early adopters), a list of eligible patients with an initial clinic visit from 1/1/2020-7/27/2020 was generated using standardized reporting techniques and confirmed by manual chart review. Physician utilization of the template was then calculated by comparing patients with data obtained from the note template to the generated list of eligible patients. RESULTS: 230 patient records met study criteria. Agreement between manual chart review and data extracted from the EHR was high (>85%). Race, ethnicity and insurance data were misclassified in about 10-15% of cases; this was due to site-specific differences in how these fields were coded. Renal ultrasound was misclassified 12% of the time; this was primarily due to outside images documented in radiology results but not included in the clinical note. All other data elements had >90% agreement (Figure). Template utilization for early adopters was >75% (75.5-87.5%). DISCUSSION: This is the first study in urology to demonstrate that use of structured data elements can support multi-center research. Limitations include: inclusion of only academic sites with the Epic EHR and lack of data on utilization and sustainability at sites without a prior history of structured template use. CONCLUSIONS: Multi-center research collaboration using EHR-based data collection tools is feasible with generally high accuracy compared to manual chart review. Additionally, sites with a long history of template adoption have high levels of provider utilization.

Predicting no-shows in paediatric orthopaedic clinics.

BACKGROUND: Clinic 'no shows' (NS) can be a burden on the healthcare system, and efforts to minimise them can reduce lost revenue and improve patient care. Leveraging a large data set via the electronic health record (EHR) has not been previously attempted to identify 'high risk' groups in paediatric orthopaedics. OBJECTIVE: To use discrete data captured by the EHR system to identify predictors of non-attendance at paediatric orthopaedic outpatient appointments. METHODS: Appointments from January 2014 to March 2016 were included. Variables included appointment status, age, gender, type of visit, payor type (government vs private insurance), distance of residence to clinic, region of residence, clinic location, clinic type, and appointment day of the week, hour and month. Classification and regression trees (CART) were constructed to identify predictors of NS. RESULTS: 131 512 encounters were included, 15 543 of which were in the NS group (11.8%). CART identified three predictive covariates for NS: days in between scheduling and appointment, insurance type, and specific orthopaedic clinic type. The combination of covariates provided predictability of NS: if they had ≤38.5 days of waiting for appointment and had private insurance, the NS rate was 7.8% (the best result), compared with waiting >38.5 days for either a fracture or sports clinic, which had an NS rate of 29.3% (OR=4.9). CONCLUSION: Payor type and duration between scheduling and appointment may predict non-attendance at outpatient paediatric orthopaedic appointments. Although these findings allow for predicting and interventions for at-risk groups, even the best performing NS group occurred 7.8% of the time, highlighting the complexity of the NS phenomenon.

Providing Access: Differences in Pediatric Portal Activation Begin at Patient Check-in.

BACKGROUND: The patient portal interface with individual electronic health records (EHR) was introduced as a tool to enhance participatory medicine. Recent studies suggest adults from racial and ethnic minorities as well as non-English speakers face disproportionate barriers to adoption; however, little data are available for pediatric patients. OBJECTIVE: The purpose of this study was to examine patient portal offers and activation patterns among pediatric urology patients at two geographically diverse tertiary pediatric hospitals. METHODS: Retrospective analysis of 2011 to 2016 electronic portal audit records was conducted among patients aged 18 and younger with at least one outpatient urology clinic visit at two tertiary academic pediatric hospitals and their affiliated networks. Differences in utilization among parents/caregivers and adolescents were examined using multivariate analysis. RESULTS: Of 44,608 individuals seen in a participating urology department during the study period, 21,815 (48.9%) were offered a code for patient portal activation; of these, 8,605 (19.3% of total eligible individuals) activated portal access. Logistic regression demonstrated associations between an offer and site (p < 0.001), being female (p < 0.001), being Asian or white (p < 0.05), being non-Hispanic (p < 0.001), and reporting English as preferred language (p < 0.001). Activating patient portal access was associated with site (p < 0.001), being Asian or white (p < 0.001), and reporting English as preferred language (p < 0.001). CONCLUSION: This study found that demographic variations in portal began with demographic differences in which patients were offered an activation code. Fewer than half of those given an access code activated their account. Preferred language, race/ethnicity, and clinic location were associated with likelihood of portal activation. Although patients are increasingly expected to schedule appointments, manage correspondence, request prescription refills, obtain authorizations and referrals, and communicate with the medical team using the portal, this study suggests that in the pediatric specialty setting many patients and caregivers are not offered the opportunity to access these tools.

Patient Portal Usage in Pediatric Urology: Is it Meaningful Use for Everyone?

INTRODUCTION: The Affordable Care Act promotes multiple directives for meaningful use of the Electronic Health Record, such as patient/provider portals, to increase patient engagement. Although portal use is common within adult healthcare, little information exists regarding pediatric portal use. We examined pediatric urology patient portal enrollment and activation patterns at a tertiary pediatric hospital in Southern California by race/ethnicity, preferred language, gender, and residential region. METHODS: Retrospective Electronic Health Record analysis of enrollment in patient portal from January 2010 to May 2016 among 10,464 patients with at least one outpatient urology clinic visit. Differences in adoption rates were examined using logistic regression for the following categories: activated (or caregiver activated); code accepted not activated; declined; or activated/then deactivated. RESULTS: Overall, 46.5% of patients/caregivers activated the portal. Primarily Spanish-speaking patients were less likely to activate (OR 0.25, p <.001) than English-speaking patients. Males (OR 0.89, p =.004); those self-identifying racially as Other (not White, Asian, or African American) (OR 0.47, p <.001); and Hispanic patients (OR 0.49, p <.001) were less likely to activate. Suburban patients were up to 3 times more likely to activate portals than central urban patients depending on the region (OR 2.94, p <.001). Multivariate logistic regression demonstrated Spanish-speaking patients were 3 times less likely to activate while controlling for demographic and region variables. CONCLUSIONS: Primary language and socioeconomic factors may be significant barriers to portal adoption. Patient education to reduce these barriers may increase portal acceptance and increase meaningfulness to the portal for patients/parents and providers.

Intraoperative pediatric acupuncture is widely accepted by parents.

OBJECTIVE: Medical acupuncture is increasingly recognized for reducing postoperative pain, nausea and emergence agitation. Anesthetic induction is an ideal time to perform acupuncture in an effort to reduce the adverse side effects of surgery. Acupuncture is safe, inexpensive and does not lengthen the duration of anesthesia. There are however no published reports of how often patients will choose intraoperative acupuncture when given the opportunity to do so. METHODS: A retrospective review of all surgical procedures performed by one surgeon over 12 months was done. This yielded 401 unique patients ranging in age from 3 months to 21 years with a mean of 6 years. Five of these patients had emergent surgery and 396 patients had scheduled surgery; there were a total of 822 surgical procedures performed on these individuals. Intraoperative acupuncture was offered only to the scheduled surgical patients. RESULTS: 388 of 396 (98%) parents chose to have intraoperative acupuncture done for their child. No complications of acupuncture were encountered. CONCLUSION: These results demonstrate strong acceptance of intraoperative acupuncture by parents. We hope this report encourages surgeons to become trained in medical acupuncture.

Quantitative determination of optical trapping strength and viscoelastic moduli inside living cells.

With the success of in vitro single-molecule force measurements obtained in recent years, the next step is to perform quantitative force measurements inside a living cell. Optical traps have proven excellent tools for manipulation, also in vivo, where they can be essentially non-invasive under correct wavelength and exposure conditions. It is a pre-requisite for in vivo quantitative force measurements that a precise and reliable force calibration of the tweezers is performed. There are well-established calibration protocols in purely viscous environments; however, as the cellular cytoplasm is viscoelastic, it would be incorrect to use a calibration procedure relying on a viscous environment. Here we demonstrate a method to perform a correct force calibration inside a living cell. This method (theoretically proposed in Fischer and Berg-Sørensen (2007 J. Opt. A: Pure Appl. Opt. 9 S239)) takes into account the viscoelastic properties of the cytoplasm and relies on a combination of active and passive recordings of the motion of the cytoplasmic object of interest. The calibration procedure allows us to extract absolute values for the viscoelastic moduli of the living cell cytoplasm as well as the force constant describing the optical trap, thus paving the way for quantitative force measurements inside the living cell. Here, we determine both the spring constant of the optical trap and the elastic contribution from the cytoplasm, influencing the motion of naturally occurring tracer particles. The viscoelastic moduli that we find are of the same order of magnitude as moduli found in other cell types by alternative methods.

Photoinduced electron transfer based ion sensing within an optical fiber.

We combine suspended-core microstructured optical fibers with the photoinduced electron transfer (PET) effect to demonstrate a new type of fluorescent optical fiber-dip sensing platform for small volume ion detection. A sensor design based on a simple model PET-fluoroionophore system and small core microstructured optical fiber capable of detecting sodium ions is demonstrated. The performance of the dip sensor operating in a high sodium concentration regime (925 ppm Na(+)) and for lower sodium concentration environments (18.4 ppm Na(+)) is explored and future approaches to improving the sensor's signal stability, sensitivity and selectivity are discussed.

Active-passive calibration of optical tweezers in viscoelastic media.

In order to use optical tweezers as a force measuring tool inside a viscoelastic medium such as the cytoplasm of a living cell, it is crucial to perform an exact force calibration within the complex medium. This is a nontrivial task, as many of the physical characteristics of the medium and probe, e.g., viscosity, elasticity, shape, and density, are often unknown. Here, we suggest how to calibrate single beam optical tweezers in a complex viscoelastic environment. At the same time, we determine viscoelastic characteristics such as friction retardation spectrum and elastic moduli of the medium. We apply and test a method suggested [M. Fischer and K. Berg-Sørensen, J. Opt. A, Pure Appl. Opt. 9, S239 (2007)], a method which combines passive and active measurements. The method is demonstrated in a simple viscous medium, water, and in a solution of entangled F-actin without cross-linkers.

Quantifying noise in optical tweezers by allan variance.

Much effort is put into minimizing noise in optical tweezers experiments because noise and drift can mask fundamental behaviours of, e.g., single molecule assays. Various initiatives have been taken to reduce or eliminate noise but it has been difficult to quantify their effect. We propose to use Allan variance as a simple and efficient method to quantify noise in optical tweezers setups.We apply the method to determine the optimal measurement time, frequency, and detection scheme, and quantify the effect of acoustic noise in the lab. The method can also be used on-the-fly for determining optimal parameters of running experiments.

Three-dimensional optical control of individual quantum dots.

We show that individual colloidal CdSe-core quantum dots can be optically trapped and manipulated in three dimensions by an infrared continuous wave laser operated at low laser powers. This makes possible utilizing quantum dots not only for visualization but also for manipulation, an important advantage for single molecule experiments. Moreover, we provide quantitative information about the magnitude of forces applicable to a single quantum dot and of the polarizability of an individual quantum dot.