Pediatric SOFA score for detecting sepsis in children

Background The pediatric logistic organ dysfunction-2 (PELOD-2) score is recommended by the Indonesian Pediatric Society Emergency and Intensive Care Working Group as an indicator of life-threatening organ dysfunction for sepsis in children. However, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) recommended the Sequential (Sepsis-related) Organ Failure Assessment (SOFA) score in determining life-threatening organ dysfunction, which has not been adjusted for pediatric patients. Objective To assess the accuracy of the pediatric SOFA score in diagnosing sepsis in children admitted to the pediatric intensive care unit (PICU) at Mohammad Hoesin Hospital, Palembang, South Sumatera. Methods The study was conducted in children with organ dysfunction caused by infection admitted in PICU, from April to December 2019. Subjects were included by consecutive sampling, according to the following inclusion criteria: all patients aged 1 month to 18 years who met organ dysfunction and two SIRS criteria, with infection according to the 2005 PSCC criteria. Laboratory tests performed included complete blood count (CBC), blood gas analysis, measurement of C-reactive protein (CRP), liver and kidney function tests. In all patients, pSOFA and PELOD-2 scores were calculated within 24 hours of admission. We compared the accuracy of pSOFA score to PELOD-2 score ≥ 11. Results Of 108 subjects, there were 59 males and 49 females, with median age 11 (range 1-193) months. We compared the accuracy of pSOFA score to PELOD-2 score ≥ 11 and obtained a sensitivity of 93.3% and a specificity of 79.5%, for pSOFA cut-off score ≥ 8. Pediatric SOFA score cutoff ≥ 8 was determined by receiver operating curve (ROC). The area under the curve (AUC) for pediatric SOFA score was 93.9% (95%CI 89.7 to 98.0%). Conclusion Pediatric SOFA score ≥ 8 is the optimal cut-off for predicting life-threatening organ dysfunction in pediatric sepsis. Multicenter revalidation is needed to find the most optimal cut-off point for general use in Indonesia.

Measuring Quality of Healthcare Outcomes in Type 2 Diabetes from Routine Data: a Seven-nation Survey Conducted by the IMIA Primary Health Care Working Group

Summary Background: The Institute of Medicine framework defines six dimensions of quality for healthcare systems: (1) safety, (2) effectiveness, (3) patient centeredness, (4) timeliness of care, (5) efficiency, and (6) equity. Large health datasets provide an opportunity to assess quality in these areas. Objective: To perform an international comparison of the measurability of the delivery of these aims, in people with type 2 diabetes mellitus (T2DM) from large datasets. Method: We conducted a survey to assess healthcare outcomes data quality of existing databases and disseminated this through professional networks. We examined the data sources used to collect the data, frequency of data uploads, and data types used for identifying people with T2DM. We compared data completeness across the six areas of healthcare quality, using selected measures pertinent to T2DM management. Results: We received 14 responses from seven countries (Australia, Canada, Italy, the Netherlands, Norway, Portugal, Turkey and the UK). Most databases reported frequent data uploads and would be capable of near real time analysis of healthcare quality. The majority of recorded data related to safety (particularly medication adverse events) and treatment efficacy (glycaemic control and microvascular disease). Data potentially measuring equity was less well recorded. Recording levels were lowest for patient-centred care, timeliness of care, and system efficiency, with the majority of databases containing no data in these areas. Databases using primary care sources had higher data quality across all areas measured. Conclusion: Data quality could be improved particularly in the areas of patient-centred care, timeliness, and efficiency. Primary care derived datasets may be most suited to healthcare quality assessment.

Measuring Quality of Healthcare Outcomes in Type 2 Diabetes from Routine Data: a Seven-nation Survey Conducted by the IMIA Primary Health Care Working Group

Summary Background: The Institute of Medicine framework defines six dimensions of quality for healthcare systems: (1) safety, (2) effectiveness, (3) patient centeredness, (4) timeliness of care, (5) efficiency, and (6) equity. Large health datasets provide an opportunity to assess quality in these areas. Objective: To perform an international comparison of the measurability of the delivery of these aims, in people with type 2 diabetes mellitus (T2DM) from large datasets. Method: We conducted a survey to assess healthcare outcomes data quality of existing databases and disseminated this through professional networks. We examined the data sources used to collect the data, frequency of data uploads, and data types used for identifying people with T2DM. We compared data completeness across the six areas of healthcare quality, using selected measures pertinent to T2DM management. Results: We received 14 responses from seven countries (Australia, Canada, Italy, the Netherlands, Norway, Portugal, Turkey and the UK). Most databases reported frequent data uploads and would be capable of near real time analysis of healthcare quality.The majority of recorded data related to safety (particularly medication adverse events) and treatment efficacy (glycaemic control and microvascular disease). Data potentially measuring equity was less well recorded. Recording levels were lowest for patient-centred care, timeliness of care, and system efficiency, with the majority of databases containing no data in these areas. Databases using primary care sources had higher data quality across all areas measured. Conclusion: Data quality could be improved particularly in the areas of patient-centred care, timeliness, and efficiency. Primary care derived datasets may be most suited to healthcare quality assessment.

Development and Early Assessment of an Organic Land Care Extension Program for Landscapers

This article presents findings from the first 3 years of implementing an organic land care training program for landscapers, including landscaper attitudes, lessons learned, and the potential role of extension. Results of a needs assessment as well as discussions with organic practitioners provided evidence that New Jersey lacked in-depth training needed to assist practitioners in determining acceptable practices when offering organic services to their clientele. As a result, Rutgers University convened an organic land care working group and developed a certificate program for professionals with the long-term goal of promoting healthy soil, enhancing biodiversity, and reducing polluted runoff from managed landscapes. Thus far the program has been attended by 63 landscapers with 48 fulfilling the program requirements. Follow-up surveys with participants of the first 2 years showed that 38% of the 1163 acres (470.6 ha) under their management are either in transition or have been completely converted to organic management. Respondents reported a significant decrease in use of synthetic fertilizers and significant increase in use of organic fertilizer. Median synthetic pesticide usage decreased by 40%. Respondents reported since attending the program they were more effective at a number of practices including removing invasives and installing native plants, installing rain gardens, reducing stormwater runoff, and reducing irrigation. Focusing on the science, patience in transitioning, and understanding there are no “one size fits all” organic programs have been important lessons learned by experienced practitioners. Clientele acceptance, product efficacy, and finding skilled staff were cited as consistent challenges. These results indicate that extension can play a lead role in conducting applied research and providing relevant, effective educational programming for landscapers in the organic land care field.

What Does Big Data Mean for Wearable Sensor Systems?

Summary Objectives:The aim of this paper is to discuss how recent developments in the field of big data may potentially impact the future use of wearable sensor systems in healthcare. Methods: The article draws on the scientific literature to support the opinions presented by the IMIA Wearable Sensors in Health-care Working Group. Results: The following is discussed: the potential for wearable sensors to generate big data; how complementary technologies, such as a smartphone, will augment the concept of a wearable sensor and alter the nature of the monitoring data created; how standards would enable sharing of data and advance scientific progress. Importantly, attention is drawn to statistical inference problems for which big datasets provide little assistance, or may hinder the identification of a useful solution. Finally, a discussion is presented on risks to privacy and possible negative consequences arising from intensive wearable sensor monitoring. Conclusions: Wearable sensors systems have the potential to generate datasets which are currently beyond our capabilities to easily organize and interpret. In order to successfully utilize wearable sensor data to infer wellbeing, and enable proactive health management, standards and ontologies must be developed which allow for data to be shared between research groups and between commercial systems, promoting the integration of these data into health information systems. However, policy and regulation will be required to ensure that the detailed nature of wearable sensor data is not misused to invade privacies or prejudice against individuals.

Guidelines on Vaccinations in Paediatric Haematology and Oncology Patients

Objective.Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children.Patients and Methods. A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed.Results and Conclusion. During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity.