Upadacitinib as salvage therapy in adolescents with acute severe ulcerative colitis refractory to conventional treatments.

Objectives: Upadacitinib (UPA), a selective Janus kinase-1 inhibitor, has demonstrated efficacy in inducing and maintaining remission in moderate to severe ulcerative colitis (UC) in adults. Current standard management for acute severe ulcerative colitis (ASUC) involves intravenous corticosteroids (IVCS) followed by infliximab (IFX) salvage therapy. Limited data exist on the utility of UPA in ASUC, particularly in adolescents.

Disparities in Patient Portal Activation and Usage at a Large Pediatric Academic Institution.

Background And Objective: Access to personal medical information promotes patient understanding of health issues and enables patient self-advocacy of healthcare needs. The advent of electronic medical record systems and the 2016 21st Century CURES Act promoted and encouraged patient access to personal medical information, yet technology-dependent modalities have often disadvantaged certain communities. We sought to evaluate whether disparities existed in access to patient portals at our institution, the main pediatric care provider in an area serving one million children.

Cross-Sectional Evaluation of Health Insurance Knowledge and Self-Efficacy in Adolescents and Young Adults with Inflammatory Bowel Disease.

Objective: To evaluate the status of health insurance knowledge and self-efficacy among adolescents and young adults with inflammatory bowel disease (AYA-IBD).

Study Design: English-proficient AYA-IBD ≥15 years receiving care at an academic pediatric practice were invited to perform the Kaiser Family Foundation survey on health information knowledge and the Health Insurance Literacy Measure. Analyses of responses by demographic factors were performed using nonparametric analyses and agreement analyses were performed to compare survey responses.

Standardizing visual display of gastrointestinal pathology results for improved clinical interpretation.

Objectives: Pathology is an essential component of disease diagnosis and management in pediatric gastroenterology. Pathology reports have not been standardized in some areas of pediatric gastrointestinal pathology and pathology reporting varies. Development of electronic medical record (EMR) pathology synoptic report templates (PSRT) enables pathology data collection in a specific format and can help standardize pathology reporting.

Electronic medical record clinical workload metrics from 10,210 gastroenterologists in North America.

In the United States, clinical work had been primarily compensated via a relative value unit (RVU) system reliant on professional surveys estimating the value of clinical care events. However, with the advent of time-based billing in 2021, time accounting has become an important work compensation metric. The Signal functionality within Epic, the most widely used electronic medical record (EMR) system in North America, tracks clinician time within the system.

Child Protection System Interactions for Children With Positive Urine Screens for Illicit Drugs.

Importance: Young children are ingesting illicit drugs at increased rates, but it is unknown what the associated child protection system (CPS) responses are when a child tests positive.

Objective: To document the child protection system involvement and the characteristics of children who test positive for illicit substances.

Design, Setting, And Participants: This retrospective cross-sectional study linked medical discharge and child protection system administrative data.

Pediatric endoscopy: how can we improve patient outcomes and ensure best practices?

Introduction: Strategies to promote high-quality endoscopy in children require consensus around pediatric-specific quality standards and indicators. Using a rigorous guideline development process, the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) was developed to support continuous quality improvement efforts within and across pediatric endoscopy services.

Areas Covered: This review presents a framework, informed by the PEnQuIN guidelines, for assessing endoscopist competence, granting procedural privileges, audit and feedback, and for skill remediation, when required.

Counts and child protection reports of diagnosed child maltreatment before and after the COVID-19 pandemic onset.

Background: Mechanisms for reporting child maltreatment (CM) were affected by changes in service provision immediately following the onset of the COVID-19 pandemic.

Objective: To examine changes in counts and CPS reporting of CM medical encounters before and after the onset of COVID-19.

Participants And Setting: All emergency department and inpatient medical encounters with at least one CM diagnosis during the study period at Rady Children's Hospital San Diego, the largest pediatric hospital in California between 2016 and November 2021.

Harnessing Electronic Medical Record Tools to Provide Proceduralist Feedback on Pediatric Endoscopy Quality Metrics.

In 2022, the Pediatric Endoscopy Quality Improvement Network published quality metrics related to pediatric endoscopy. We utilized electronic medical record (EMR) tools to collect pediatric endoscopy quality metrics (PEQM) and to standardize proceduralist feedback. EMR tools were created to capture and display PEQM: (1) an endoscopy documentation template, (2) nursing documentation of events during endoscopy for timed calculations, and (3) a data dashboard.

The Impact of COVID-19 on Infant Maltreatment Emergency Department and Inpatient Medical Encounters.

Objective: To assess the counts of infant maltreatment-related medical encounters at a large medical system during a 21-month span of the COVID-19 pandemic.

Methods: Retrospective data for this study came from all inpatient and emergency department medical encounters for infants from January 1, 2016, through November 30, 2021, at a single children's hospital system in California. Distributions of medical encounters were tabulated and plotted over time.

Improving Hepatitis B Screening at Family Health Centers Using Quality Improvement and Electronic Medical Record Tools.

Chronic hepatitis B viral (HBV) infection is associated with significant morbidity and mortality with endemic areas carrying most of the global burden of HBV disease. Current HBV screening rates in the United States are suboptimal. We aimed to improve HBV screening rates at regional family health centers serving high-risk refugee populations by 20% over 2 years.

A Longitudinal Study of Health Care Utilization Among Infants Investigated for Maltreatment.

Objective: To evaluate whether maltreatment investigated during infancy affects high-acuity health care utilization patterns during early childhood.

Methods: Retrospective case-control study based on linked data between child protection and hospital encounter records conducted to review health records of infants investigated for abuse and/or neglect. Cases and controls were followed longitudinally through the Rady Children's Hospital electronic health records for 4 years starting at the age of 1 year.

Ingestion of Illicit Substances by Young Children Before and During the COVID-19 Pandemic.

Importance: Information about the trend in illicit substance ingestions among young children during the pandemic is limited.

Objectives: To assess immediate and sustained changes in overall illicit substance ingestion rates among children younger than 6 years before and during the COVID-19 pandemic and to examine changes by substance type (amphetamines, benzodiazepines, cannabis, cocaine, ethanol, and opioids) while controlling for differing statewide medicinal and recreational cannabis legalization policies.

Design, Setting, And Participants: Retrospective cross-sectional study using an interrupted time series at 46 tertiary care children's hospitals within the Pediatric Health Information System (PHIS).

Electronic Medical Records: Use as Tools for Improving Quality in Pediatric Endoscopy.

Quality indicators and standards for pediatric endoscopy have recently been developed by the inaugural working group of the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN). Currently available electronic medical record (EMR) functionalities can enable real-time capture of quality indicators to support continuous quality measurement and improvement within pediatric endoscopy facilities. Ultimately, EMR interoperability and cross-institutional data sharing can serve to validate PEnQuIN standards of care and permit benchmarking across endoscopy services, in the pursuit of elevating the quality of endoscopic care for children everywhere.

Evaluating Transition Readiness: Is Self-Report Valid as the Gold Standard?

Objective: Determination of transitional readiness is an essential component of delivery of transition services to adolescents and young adults with chronic diseases, including those with inflammatory bowel disease (IBD). To date, this has been performed using the transition checklist (TC). However, clinical experience suggests the validity of the checklist may not be ideal.

Transition of care of patients with eosinophilic gastrointestinal diseases: Challenges and opportunities.

Eosinophilic gastrointestinal disorders (EGID) are a group of allergen-mediated conditions which are characterized by eosinophilic inflammation affecting one or more parts of the gastrointestinal tract. A disproportionately higher number of EGID patients are diagnosed in the pediatric age group. Given the chronic course of EGIDs and lack of curative therapies at this time, majority of the pediatric EGID patients may require continued care well into their adulthood.

Hold that pose: capturing cervical dystonia's head deviation severity from video.

Objective: Deviated head posture is a defining characteristic of cervical dystonia (CD). Head posture severity is typically quantified with clinical rating scales such as the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Because clinical rating scales are inherently subjective, they are susceptible to variability that reduces their sensitivity as outcome measures.

Caregiver Insights and Improvement Strategies for Youth with Autism Undergoing Gastrointestinal Endoscopy.

Limited guidance is available for families of youth with ASD (YASD) to prepare for invasive medical procedures. This study examined caregiver perspectives regarding YASD's gastrointestinal endoscopy (GE) experience to improve the endoscopy experience for YASD. Thirty-four caregivers of YASD, (M = 9.

Hispanic parental perceptions about telemedicine: Potential targets for interventions to improve access to care.

Introduction: One benefit of the COVID-19 pandemic has been the growth and expansion of telemedicine capabilities with the potential to improve access to healthcare in the face of social isolation mandates. However, adoption of telemedicine has been suboptimal in the Hispanic community and data has been sparse regarding Hispanic experiences with and opinions regarding telemedicine.

Methods: To gather feedback regarding telemedicine and to identify potential barriers to telemedicine use in the Hispanic community, we performed semi-structured interviews about telemedicine experiences among both Hispanic and non-Hispanic parents who had performed both in-person and at least one telemedicine visit for their child at our institution.