April 15, 2024

3 min read

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Key takeaways:

• Replacing answering services and paper forms with AI can improve patient and provider satisfaction.
• Choosing technology that integrates with your EHR is crucial.

DENVER — Incorporating artificial intelligence into daily practice can benefit both providers and patients, according to experts here at the American Academy of Neurology annual meeting.

In a panel discussion, Louis A. Tramontozzi, III, MD, a neurologist in private practice at North Shore Neurology in Massachusetts, detailed how his team has implemented several AI-related tools to improve provider and staff productivity and wellbeing, while generating cost savings and a positive impact on patient satisfaction.

A panel of experts weighed in on the benefits of AI in daily practice. Image: Adobe Stock

Tramontozzi’s practice, which consists of about nine providers, receives up to 800 patient phone calls per day and 20 voicemails per hour. This call volume was the impetus, he said, to firing their answering service and hiring a robot. Now, when a patient leaves a voicemail, the audio is immediately and automatically transcribed and input into the patient’s chart and assigned to a staff member.

“This has allowed us to keep the patients front and center, so our staff are interacting with patients instead of being on the phone. And they’re able to turn around some phone calls, our record is in 2 to 5 minutes, which is unbelievable,” he said. “It’s helped our staff to feel more empowered as well, and that they’re valued more [because] the work they’re actually doing is much more meaningful than listening to voicemails and transcribing.”

Panelist Leeann Garms, chief executive officer of Raleigh Neurology Associates in North Carolina, said this type of AI has the potential to create “good friction” in the system because patients and providers are interacting in a more meaningful way. For those in a position to make this switch, Garms suggested starting with night calls, then migrating to daytime calls if it makes sense for your practice.

“With any change, it’s all about messaging,” Tramontozzi said. He suggested practices make patients aware of changes — like those implemented with the voicemail software — via an email blast to portal members, or as part of the provider’s script at the end of new patient visits.

Patient intake and consent forms are another area that has been improved by AI for both Tramontozzi and Garms. One year ago, new patients in Tramontozzi’s practice were handed a clipboard, pen and various intake and consent forms, which were often only partially completed, if at all. Then, staff were tasked with prepping and inputting all the information into the electronic health record, a job they hated, he said. Now, new patients receive secure text messages with intake paperwork and consent forms to be filled out prior to their visit, and the information patients provide is automatically populated in their chart. If this system presents a challenge, the practice has iPads at the office that can be used to assist the patients.

“Our staff are no longer prepping,” Tramontozzi said. “They’re much happier and we have a higher chance of retaining them and getting them back to meaningful work, and that is really empowering for all of us no matter what job we have.”

Another bonus for Tramontozzi is that for simpler patient visits, the history of present illness, or HPI, is essentially written for him based on the information the patient provides during intake. When setting up this new system, the practice collaborated with the tech company to design intake forms for specific disease states, like headache, so the HPI would be most accurate. This allows providers to spend more meaningful time with patients, leaving more time for clarification and critical thinking, he said.

For patients who may feel frustrated with the integration of more technology, Garms said it helps to incentivize them by explaining the benefits it has on their time.

“As a selling point to the pushback of ‘I don’t want to use these things,’ that’s what the incentive is: they get their service faster, they’re spending time with the people they expected to spend time with and get what they needed at visit,” she said.

For anyone looking to implement these types of AI into their practice, Garms and Tramontozzi said the first step is connecting with your EHR vendor. They often have a list of AI vendors they integrate with. They also suggested networking with colleagues who have implemented this type of technology. But the most crucial step is choosing technology that integrates with your EHR.

“That’s the first barrier that you need to solve because you don’t want to pay extra for computer science engineers,” Tramontozzi said. “It has to be integrated.”

Sources/Disclosures

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Source:

Garms L, et al. ChatPMT: Ask the practice management expert. Presented at: American Academy of Neurology annual meeting; April 13-18, 2024; Denver.

Disclosures:
Garms and Tramontozzi report no relevant financial disclosures.

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April 15, 2024

4 min read

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Key takeaways:

• Studies have shown that shorter antibiotic courses are just as effective as longer ones for some infections.
• In pediatrics, strep pharyngitis, sinusitis and ear infections are targets for improvement.

Many studies have shown that shorter courses of antibiotic therapy are just as effective as longer ones for certain infections, including those that impact children. The idea is commonly referred to using the mantra “shorter is better.”

In an article published in the Journal of the Pediatric Infectious Diseases Society, physicians outlined the evidence supporting shorter antibiotic courses for three common pediatric upper respiratory tract infections and discussed the impact that academic imprinting has on prescribing practices in pediatrics.

We spoke with two of the authors — Rana E. El Feghaly, MD, MSCI, director of the outpatient antibiotic stewardship program at Children’s Mercy Kansas City, and Nicole M. Poole MD, MPH, associate medical director of the antimicrobial stewardship program at Children’s Hospital Colorado — to learn more.

Healio: Do you think the message that long antibiotic courses may not be necessary for many common illnesses has been received by most pediatricians?

Poole: The short answer is no, because antibiotics continue to be prescribed for long durations for many common illnesses. A challenge is that guidelines come out infrequently and new, more current research is available that is sometimes difficult for clinicians in a busy practice to keep up with. Overall, clinicians are open to prescribing shorter durations, which is why we thought it was so important to review the data in one article and be able to discuss how we can recalibrate what we consider default durations for these very common illnesses.

El Feghaly: I am not sure the message has been shared with most pediatricians yet! Studies have shown that prescribers and parents do not have reservations about shorter courses of antibiotics if they know they would be as effective as longer courses. This is where antimicrobial stewards can focus their efforts because it seems to me to be a low-hanging fruit for quality improvement efforts. In fact, investigators in Chicago found that merely changing the medical record’s preset durations allowed for substantial improvement in antibiotic duration use.

Healio: In the paper, you specifically mention group A strep pharyngitis, acute otitis media and acute bacterial rhinosinusitis. There are other illnesses — like community-acquired pneumonia (CAP) and UTI — that also may be treated with shorter than recommended courses. Why did you focus on those three?

El Feghaly: You are correct: The list we included is not exhaustive, and studies suggest that 5-day courses for UTI and CAP would be absolutely safe in children, but focusing on the three most common upper respiratory infections that result in antibiotic prescriptions made good sense as an initial effort.

Nicole Poole

Poole: Strep pharyngitis, sinusitis and ear infections are high-impact targets for improvement to decrease unnecessary antibiotic exposure in millions of children nationwide.

El Feghaly: Maybe we should be writing a “Give me 5” 2.0 article to address UTI and CAP! [Editor’s note: The title of the paper is, “‘Give Me Five’: The Case for 5 Days of Antibiotics as the Default Duration for Acute Respiratory Tract Infections.”]

Healio: Can you explain academic imprinting and the effect it has on prescribing?

Poole: Academic imprinting is a strong adherence to — and a bit of fear about straying away from — what’s already established in medical practice, often based on early studies. For antibiotic prescribing, the focus wasn’t initially on how long you should take them or the risks of antibiotic overuse, and long durations were chosen. But since those studies, we have seen many changes in common infections — such as shifts in disease epidemiology after effective vaccine campaigns and understanding the many harms of antibiotic overuse.

We have also identified opportunities to increase the quality and safety of our clinical practices through large observational and smaller prospective studies. But because of academic imprinting, we often stick to outdated approaches because of our high academic standards. The burden of proof to change practice typically rests on rigorous multicentered prospective randomized studies that would require large and often unattainable participant numbers to statistically measure rare outcomes.

The thing is, these foundational studies that set the standard often had less rigorous methods than we tend to accept now, yet they still dictate practice because it is how we’ve always done it. To move medicine forward, we must challenge these ingrained practices.

Healio: What are some other reasons that guidelines haven’t necessarily changed for some of these conditions, or that prescribers may still opt for longer durations of antibiotics despite evidence showing that shorter courses work?

El Feghaly: The process of updating national guidelines is a collaborative effort that requires extensive review of the literature that can be undertaken only every few years, whereas new investigations continue to be published at a relatively fast pace. The guidelines we mention in our article are all over 10 years old. We have no doubt that when the new guidelines come out for these three diagnoses, they will include newer data, and we hope they will recommend shorter durations.

Poole: As for prescribers, I think they do often rely on national guidelines, and there can be a hesitation to prescribing differently, even with the understanding that guidelines might be archived or outdated. Going back to academic imprinting, there are also beliefs that have been long held but not completely accurate, such as the historical belief that there is a serious need to finish all your antibiotics — which was often 10 to 14 days — to prevent antibiotic resistance.

Prescribing short durations of antibiotics is a culture shift in our field in many ways, and I am grateful that many investigators have been studying how to push pediatrics forward for the benefit of our patients. We need to get the word out widely about current evidence so that prescribers feel empowered to provide the highest quality of care to their patient.

As mentioned in the article, parents are very open to shorter durations of therapy and trust clinician recommendations. When parents understand that fewer days of antibiotic are effective and safer, this could also help propel the “shorter is better” practice of antibiotic prescribing. We shouldn’t overlook the significance for parents of reducing the task of giving medication to a 2-year-old by 5 days.

El Feghaly: Although outpatient antimicrobial stewardship is getting a little more attention recently, it is still not where it needs to be in terms of resource allocation and support. Knowing that most antibiotics are prescribed in ambulatory settings, we need to do better! But if you are an antibiotic steward with no significant time or staff support for outpatient efforts, know that focusing those limited resources to duration may take you a long way! Also, resources other than guidelines are available on multiple platforms, such as clinical pathways from large institutions. Prescribers can use these resources to help them use the most updated evidence-based information.

References:

El Feghaly RE, et al. J Pediatric Infect Dis Soc. 2024;doi:10.1093/jpids/piae034.

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Healio Interviews

Disclosures:
El Feghaly reports receiving grant funding from Merck. Poole reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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April 15, 2024

2 min read

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Key takeaways:

• Replacing sinks in a pediatric ward did not end an outbreak of drug-resistant bacteria but core infection prevention measures did.
• Bacteria may have been transmitted between adjoining rooms via sink drains.

Replacing contaminated sinks did not end an outbreak of multidrug-resistant bacteria in a Japanese pediatric ward but other infection prevention measures did, such as forbidding mouth-washing using sink water, researchers reported.

Over the years, numerous reports have detailed the spread of multidrug-resistant organisms via hospital sinks, sink drains and plumbing, and the potential for bacteria to colonize patients and other areas.

A combination of infection prevention steps helped stop a monthslong CPE outbreak in a pediatric ward in Tokyo. Image: Adobe Stock

Facilities have even replaced parts of plumbing systems to stop outbreaks, to no avail. One hospital replaced sink drains and traps to stop an outbreak in its ICU and was hit with a new, different outbreak.

The new study, which was published in the American Journal of Infection Control, describes a roughly 7-month multispecies outbreak of carbapenemase-producing Enterobacterales (CPE) in a pediatric ward in Tokyo in 2017. The outbreak included strains of Klebsiella pneumoniae and Escherichia coli, among other bacteria.

The outbreak occurred at Toho University Omori Medical Center, a 916-bed academic medical center with 55 pediatric inpatient beds. According to the study, the first infection was detected in a 1-year-old male patient hospitalized with cardiac disease for 4 months. The patient was diagnosed with Klebsiella variicola in June 2016.

A second infection — with Klebsiella quasipneumoniae containing the same resistance gene as the first patient — was detected 9 months later in March 2017 in a 15-year-old boy. Within 20 days, two more patients were diagnosed based on urine samples and the hospital declared an outbreak in April 2017. By October 2017, when the outbreak was declared over, there had been a total of 19 patients who tested positive for CPE.

The hospital conducted an epidemiological investigation to determine the route of transmission between patients, which included sampling patient room and implementing active surveillance for all pediatric stool samples submitted for lab testing.

The investigation detected CPE in nine sinks in the hospital’s pediatric ward, including in six hospital rooms, a nurse center, a waste room and an ice machine. Of 16 patient rooms, seven had a history of patients with CPE during the surveillance period and six of the seven rooms had CPE-positive sinks.

The investigation also found evidence that pathogens were transmitted between sinks in adjoining rooms through the drains and connected plumbing.

An infection control team reviewed routine infection prevention practices — including hand hygiene, use of gowns and gloves and antimicrobial use — and disinfected all sinks and related areas. The bacteria proved difficult to eradicate, however, leading the hospital to replace all sinks in the pediatric ward in June 2017, and to disinfect the new sinks with hydrogen peroxide.

Still, CPE contamination persisted until the infection prevention team recommended several additional measures that eventually stopped the outbreak:

• hand disinfection after using a sink;
• restricting items placed near sinks;
• using disposable tools to clean sinks;
• disinfecting all sinks with hydrogen peroxide;
• prohibiting mouth-washing using sink water;
• disinfection and drying procedures for water-exposed items;
• staff re-education on hand hygiene and infection control practices; and
• accepting of external guidance and evaluation

“After months of intense infection control protocols, we were at last able to declare an end to this outbreak,” Sadako Yoshizawa, MD, PhD, deputy director of the clinical laboratory at Toho University Omori Medical Center, said in a press release. “Our experience highlights the importance of focusing on sinks and other water-related areas in hospital wards, as these are critical for CPE transmission and, therefore, major fronts in the fight against antibiotic resistance,” Yoshizawa said.

References:

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April 11, 2024

4 min read

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Key takeaways:

• Pediatricians routinely counsel patients and families about firearm injuries and motor vehicle crashes.
• A new article offers anticipatory guidance on another top cause of death in children: overdose.

Two pediatric addiction medical specialists and a mother who lost her daughter to fentanyl poisoning collaborated to write anticipatory guidance that may help pediatricians counsel patients and families on overdose prevention strategies.

“Pediatricians routinely provide anticipatory guidance to patients and families regarding the top two causes of death in children — firearm injuries and motor vehicle crashes,” Scott E. Hadland, MD, MPH, MS; Deb M. Schmill, BS, and Sarah M. Bagley, MD, MS, wrote in Pediatrics. “[W]e believe there is now an urgent need for pediatricians to counsel adolescents and families on potentially lifesaving overdose prevention strategies.”

We spoke with Bagley, an associate professor of medicine and pediatrics at the Boston University Chobanian & Avedisian School of Medicine, and Hadland, who is division chief of adolescent and young adult medicine at Massachusetts General for Children and Harvard Medical School, about the recommendations, which they hope will become formal guidance.

Healio: What is the need for anticipatory guidance on counseling adolescents and families about overdose prevention, and why now?

Bagley: Teen overdoses have significantly increased in recent years, and we have not had a standardized way to ensure that they have access to information about overdose prevention. Pediatric providers regularly provide guidance to patients and families about injury prevention. Given that overdose is a leading cause of teen death and is preventable, it makes sense to have this guidance now.

Hadland: Overdose deaths in teens have reached an all-time high and are now the third leading cause of death in children under age 19 in the United States. Pediatricians already provide anticipatory guidance for the top two causes of death — firearms and motor vehicle crashes. Fentanyl poisonings and overdoses now need this same attention.

Healio: How should a pediatrician initiate the conversation with patients and parents?

Bagley: Pediatricians can start by saying something like, “In recent years, there have been changes in the risk of overdose in teens. Because of that, I like to talk to all my patients and their families about how to protect themselves against having an overdose and how to recognize and respond to an overdose they might see.” In the paper, there is a table with suggested language: “It’s important that we talk about safety. As you might know, the number of teen drug overdoses has been increasing. I now talk all my teen patients and their families about how to prevent and respond to an overdose.”

Healio: What steps come after that?

Bagley: An important first step is to find out what people already know. Many families have been impacted and we don’t want to make assumptions about their prior experiences. Based on the response, the pediatric provider can then provide information about the presence of fentanyl in pressed pills and drugs such as cocaine.

Here are some of the key points to cover: It’s important to emphasize that someone might not know that there is fentanyl in the substance they might be taking — or their friend might be taking. Providers can review risks for overdose, such as using alone and taking pills that are not prescribed to them. Then we want to teach the signs of an overdose and what to do in case they suspect someone might be experiencing an overdose, including calling 911. The next step is making sure patients and families know where to get naloxone — it’s available over the counter, or the provider can write a prescription if that is preferred. Part of the conversation should happen confidentially with the teen. It’s good to end with giving the teen and family an opportunity to ask questions, “what questions do you have”?

Hadland: We see important steps as:

• confidentially assessing the teen’s prior fentanyl use or exposure;
• providing education about fentanyl;
• reviewing signs of overdose;
• reviewing how to respond to an overdose; and
• discussing naloxone and how to find it.

Healio: Your perspective does not mention stigma, which is an important part of the conversation about addiction and harm reduction. Should addressing stigma be a part of formal guidance?

Bagley: That’s an important question. Stigma continues to play an important role in prevention, treatment and harm reduction. I think that one of the hopes with this paper is to suggest a universal approach that can normalize the conversations around overdose, which can lead to a decrease in stigma.

Hadland: Stigma is a critical barrier to folks receiving care. Although we don’t go into depth on stigma in the piece (we do in our other work), we believe that by normalizing these conversations — having them with every teen and family — we’re in fact helping to battle stigma, by helping teens and families understand that anyone can be affected by this crisis, and that safety is our number one priority.

Healio: Are there misconceptions about overdose prevention?

Bagley: I think that a lot of the misconceptions are related to stigma and teens, families and communities thinking that overdose is not really a problem for teens. One thing that I have found by having conversations about overdose prevention with teens is that it can open the door to other discussions about risk behaviors because we are creating a safe space for teens to ask questions that might be on their minds.

Hadland: Some might argue that counseling teens on overdose prevention might cause them to use more drugs — that somehow, this conversation will enable drug use. This is a common misconception, and similar arguments have been made about condoms — for example, that they’ll lead to teens having more sex — and other public health issues. This misconception has been proven wrong time and time again.

Healio: Do you expect these to become formal guidelines, and is there anything else you would like to see done?

Hadland: Our hope is for this to become formal guidance, and we plan to advocate as such.

Bagley: Although this paper is focused on overdose prevention in pediatric settings, there is a need to ensure that overdose education and naloxone is widely available for youth in other settings such as schools. I think that it’s also important to note that pediatric providers are being asked to do more and more in primary care. As we advocate for guidelines like this, we also need to make sure that providers are receiving the support to implement the counseling. Finally, these conversations can always start with the clear message that no use is the safest while still making sure they have information about overdose risk they need to stay as safe.

[Editor’s note: Schmill is president of the Becca Schmill Foundation.]

References:

Hadland SE, et al. Pediatrics. 2024;doi:10.10.1542/peds.2023-065217.

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Healio Interviews

Disclosures:
Hadland reports serving as a member of the editorial board of Pediatrics. Bagley and Schmill report no relevant financial disclosures.

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April 12, 2024

3 min read

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Key takeaways:

• Omalizumab reduced exacerbations by 93% over 6 years.
• Dupilumab significantly improved quality of life.
• Tezepelumab, mepolizumab and benralizumab also offer benefits.

WASHINGTON — Physicians have a variety of safe and effective biologic choices for treating children with asthma, according to a presentation at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

“This has revolutionized how we manage asthma,” Eric Schauberger, DO, PhD, assistant professor, University of Wisconsin-Madison, said during his presentation. “We now have access to these fantastic medications.”

Biologics are now available to treat asthma in children as young as age 6 years. Image: Adobe Stock

These treatments address high type 2, eosinophilic, allergic and non-type 2 asthma alike, he continued.

“Really what’s new here, though, is the long-term safety and efficacy data that has now been trickling down from all these extension studies in the so called ‘real life, real world’ uses of medications,” Schauberger said.

In fact, Schauberger said that the safety of these medications is a common topic discussed among physicians and families, such as whether these biologics are safer than just taking steroids.

Calling it the “granddaddy of them all,” Schauberger said that omalizumab (Xolair; Genentech, Novartis) targets children age 6 years and older with severe persistent asthma whose symptoms have been inadequately controlled with inhaled corticosteroids (ICS).

These patients also have had a positive skin test or in vitro reactivity to a perennial aeroallergen, he said.

Noting a 2023 study from Spain, Schauberger said that omalizumab reduced exacerbations by 96% and decreased the direct costs of asthma by 93% over 6 years in children with severe pediatric asthma.

“However, the drug is not free,” he said, adding that omalizumab increased costs by a factor of 2.5 to three, although overall the treatment was cost-effective due to the reductions in exacerbations.

Savings in year 1 with omalizumab included 2,107 euro per avoided exacerbation, 2,059 euro per 0.5-point improvement in Asthma Control Questionnaire score and 3,141 euro per three-point improvement in Childhood Asthma Control Test score.

Schauberger also noted that the study did not account for attributable costs such as missed work and school, which would have added to the biologic’s cost-effectiveness.

Studies of dupilumab (Dupixent; Regeneron, Sanofi), which targets patients aged 6 years and older with moderate-to-severe asthma characterized by an eosinophilic phenotype and dependence on oral corticosteroids, also yielded positive results, Schauberger said.

For example, the Liberty Asthma Voyage study found reduced exacerbations in children aged 6 to 11 years with type 2 asthma whether or not they had evidence of allergic asthma, with similar trends in changes in their lung function.

“Then there was significant improvement in asthma control observed in patients with evidence of allergic asthma, but not in those without,” Schauberger said. “So even if you’re not allergic, it still does help, but not as much.”

A post hoc analysis of the Liberty Asthma Voyage study also found significantly improved quality of life for these children and their caregivers.

“We also take care of the parents, the families as well,” Schauberger said.

In the Liberty Asthma Venture study, dupilumab led to reductions in asthma exacerbation rates and improvements in lung function, asthma control and health-related quality of life in adults and adolescents who did or did not have evidence of allergic asthma.

“So, a lot of good data basically showing definitely some improvement in not only managing the asthma outcomes from the biomarkers we’re looking at, but also in the quality of life of the patients and their families,” Schauberger said.

Approved in 2021, tezepelumab (Tezspire; Amgen, AstraZeneca) treats patients aged 12 years and older with severe asthma that has been inadequately controlled even with high ICS doses combined with other treatment for maintenance.

Adolescents and adults with severe, uncontrolled asthma in the Destination study tolerated treatment with tezepelumab well and experienced reductions in their annualized asthma exacerbation rates over 104 weeks, compared with placebo.

“That’s 2 years of good data there,” Schauberger said.

Additionally, Schauberger cited mepolizumab (Nucala, GSK) for children aged 6 years and older with severe eosinophilic asthma and benralizumab (Fasenra, AstraZeneca) for children aged 12 years and older with severe asthma and an eosinophilic phenotype, although the FDA has since approved benralizumab for children aged 6 years and older as well.

Considering these choices, Schauberger said that “choosing the appropriate medication on typing is, no doubt, very important.”

“As we get more data, we’re going to figure out which of these medications is going to work best for the patients,” Schauberger said.

Sources/Disclosures

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Source:

Schauberger E, et al. Hot topics in pediatrics: Asthma and respiratory disease in pediatric patients. Presented at: AAAAI Annual Meeting; Feb. 23-26, 2023; Washington, D.C.

Disclosures:
Schauberger reports that he is an article coauthor on UpToDate.

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April 12, 2024

2 min read

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Key takeaways:

• COVID-19 does not increase the risk for asthma in children, a study showed.
• Factors such as Black race, food allergies and allergic rhinitis did increase the risk.

Researchers found no association between a positive COVID-19 test and the development of asthma in children, according to a study published in Pediatrics.

Children with asthma have shown resilience following bouts with COVID-19, but whether or not the disease makes children without asthma more susceptible to it has been less explored.

“The COVID-19 pandemic altered our lives in many ways. One major concern was if there were going to be lasting effects of infection with the SARS-CoV-2 virus in kids — in particular, whether SARS-CoV-2 infection would increase the risk of chronic respiratory conditions such as asthma,” David A. Hill, MD, PhD, attending physician in the division of allergy and immunology at The Children’s Hospital of Philadelphia, told Healio.

Hill and colleagues conducted a retrospective cohort study of 27,423 children aged 1 through 16 years in the Children’s Hospital of Philadelphia Care Network who received a PCR test during the first year of the pandemic. Their methodology “was only possible because of the pandemic itself,” according to Hill.

“Early in the pandemic, we had a good test for SARS-CoV-2 infection (the PCR test) and we were performing that test on a lot of kids,” Hill said. “Some of these kids had SARS-CoV-2, but others did not. By comparing the rates of asthma development in these two populations, we were well positioned to determine whether SARS-CoV-2 infection was associated with asthma development.”

According to their findings, positive tests were not associated with new asthma diagnoses during an 18-month follow-up period. Specifically, PCR positivity had no significant effect on the hazard of new asthma diagnosis (HR = 0.96; 95% CI, 0.73–1.27), although factors such as Black race (HR = 1.49; 95% CI, 1.13–1.95), food allergy (HR = 1.26; 95% CI, 1.03–1.55) and allergic rhinitis (HR = 2.3; 95% CI, 1.93–2.74) significantly increased the risk for a new asthma diagnosis.

Among children aged younger than 5 years, preterm birth (HR = 1.48; 95% CI, 1.13–1.93) and BMI (HR = 1.13; 95% CI, 1.07–1.19) increased the risk for a new diagnosis as well.

“There is considerable evidence that viral respiratory infections other than SARS-CoV-2 increase risk of asthma development,” Hill said. “As such, we expected to see a similar association with SARS-CoV-2. I would say that the major conclusion of the study — that SARS-CoV-2 infection is not associated with asthma— was a welcome surprise, but a surprise nonetheless.”

Hill said the findings should help primary care providers and pediatricians reassure patients and their families.

“I’m hopeful that this study will lead to one less thing to worry about when it comes to trying to raise healthy and happy children,” Hill said. “This is reassuring, as it strengthens our ability to say that there is likely not an association between SARS-CoV-2 and asthma in kids.”

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April 12, 2024

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Key takeaways:

• Labcorp has received FDA emergency use authorization for its Mpox PCR Test Home Collection Kit.
• This test is now available for physicians to purchase.

The FDA has granted emergency use authorization for Labcorp’s Mpox PCR Test Home Collection Kit, the company announced in a press release.

The [polymerase chain reaction (PCR)] test kit is the first at-home collection kit authorized by the FDA to aid in the diagnosis of infection with non-variola orthopoxvirus, which includes the mpox virus.

The FDA has granted emergency use authorization for Labcorp’s Mpox PCR Test Home Collection Kit. Image: Adobe Stock.

This authorization from the FDA comes amid increasing reports of mpox cases. According to the CDC, there have been 511 mpox cases reported through March 16, a stark uptick from the fewer than 300 cases reported by the same time last year.

To date, the CDC reports there have been more than 32,000 cases of mpox and 58 deaths related to the disease reported nationwide.

“The FDA’s emergency authorization of Labcorp’s Mpox PCR Test Home Collection Kit will enable us to play a vital role within the health care community in the early detection and management of mpox,” Brian Caveney, MD, JD, MPH, Labcorp’s chief medical and scientific officer, said in the release.

Physicians can now order this test through Labcorp’s provider interface platform for patients aged 18 years or older who are suspected of mpox infection. The kit includes detailed instructions for patients, including how to prepare the package for return to an authorized laboratory for analysis. Once tested, results will be electronically delivered to the prescribing physician and uploaded to the patient’s Labcorp portal.

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April 13, 2024

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SHEA Spring is back with a new theme: “The Future is Now: Implementing Change through People, Policy and Technology.”

The conference, which is run by the Society for Healthcare Epidemiology of America (SHEA), is being held at the Westin Galleria Houston from April 16 to 19.

SHEA Spring will take place in Houston from April 16 to 19.

SHEA Spring typically focuses heavily on emerging issues in health care epidemiology and antibiotic stewardship. This year’s meeting will also include new research and discussions on long-term care, research methods, clinical microbiology, patient safety and quality, implementation science and COVID-19, according to SHEA.

Additionally, organizers have planned numerous networking and special events that will take place during the conference, including SHEA’s first ever service project, in which attendees will have the opportunity to assemble “superhero kits” for children with chronic illnesses and their families.

Click here to read Healio’s coverage of past SHEA Spring meetings, and please check back throughout the week for on-site coverage of this year’s conference.

References:

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April 12, 2024

7 min read

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Key takeaways:

• Clinicians should understand what SDOH are prevalent in their communities.
• There are several screening tools that can help identify adverse SDOH.
• Solutions to adverse SDOH should be local, one expert said.

Building community partnerships, having community specialists within a care team and using screening tools are all necessary steps to identifying and addressing social needs, according to experts.

Previous research has shown that adverse social determinants of health (SDOH) can lead to negative health outcomes such as higher odds of ED use and CVD mortality.

Efforts to address SDOH in clinical settings “is a relatively burgeoning field,” Mary Catherine E. Arbour, MD, MPH, an assistant professor of medicine at Harvard Medical School and medical director of the social care team at Brigham and Women’s Hospital’s Primary Care Center, told Healio. “In the last 10 years, we’ve learned a ton about how to do this work.”

Arbour and colleagues recently developed a primary care housing program, which involved hiring two community workers specializing in housing needs who worked with patients on finding shelter placement, housing applications, landlord or property management negotiations and other services. Findings showed that the program reduced primary care visits among participants and helped create stronger relationships between primary care providers and patients.

Enlarge  Resources suggested by Russell W. Kohl, MD, FAAFP.

Progress comes as adverse SDOH have continued to rise in the last half decade. According to the U.S. Department of Agriculture, the prevalence of food insecurity rose from 10.2% to 13.5% from 2021 to 2022. Additionally, a 2019 Kaiser Permanente survey showed that 68% of Americans had at least one unmet social need within the last year, whereas 21% prioritized food or rent over seeing a doctor or receiving medication.

As a result, primary care physicians must “be savvy at asking patients and identifying these needs and having appropriate counterparts, be they part of the office staff, part of the clinical team or community-based partners who can keep abreast of all of the changing social resources that are out there,” Arbour said.

Providers must understand SDOH domains, stigmas

Arbour explained that PCPs should understand what the prevalent domains of social need are among their patient population.

According to the HHS’ Healthy People 2030 initiative, there are five domains that SDOH can be grouped into:

• economic stability;
• education access and quality;
• social and community context;
• neighborhood and built environment (referring to physical spaces made for living, recreation and work); and
• health care access and quality.

Clinicians should also be aware that answering questions about social needs can be risky for the patient.

“For example, if I’m a mother of young children and I tell you that I have food insecurity, there may be a risk — or at least a stigma — and some shame associated with not being able to provide everything my children need,” Arbour noted. “Doctors need to be sensitive to the fact that someone who’s disclosing this sort of information is in a vulnerable position.”

Importance of team-based care

Arbour noted that to effectively address social needs and risks, “there really needs to be other members of the care team who have expertise in connecting with patients around these needs and then accessing resources that are available or accessing community-based organizations that provide additional resources to patients.”

In Arbour’s care team, for example, there are community resource specialists who not only provide information about SDOH domains to patients but can help them navigate through the extensive process of getting the resources they need.

“If you’ve ever tried to navigate any kind of a public system, you’ll know that there’s rooms of paperwork,” she explained. “It’s hard to know and do everything correctly to get through one of these processes, and our community health workers do an excellent job of helping patients overcome the typical barriers in a system — whether those barriers are due to convoluted processes, or whether those barriers are exacerbated by things like low literacy levels or language barriers.”

Screening tools, resource locaters are ‘critical’

Social needs, like diseases and other medical conditions, can be effectively identified using screening tools. Several major medical organizations offer SDOH-based screening tools, including:

“I think it’s really critical that folks use one of those tools,” Russell W. Kohl, MD, FAAFP, a family physician and speaker of the AAFP Congress of Delegates, told Healio. “That objective screening is what we don’t see in practice as much as perhaps our patients actually need.”

He explained that screenings can help to identify certain adverse SDOH that may not be immediately obvious to clinicians.

“One of the populations that [I’ve seen] a lot more of over the last year… is folks who are unhoused but are living in their cars and are working very hard to prevent anyone from figuring out that they’re unhoused,” he said. “That’s not somebody who, when they come into the office, is going to necessarily set off alarm bells for you… Having a screening tool to start is key, because your assumptions about people are not always going to be correct.”

Kohl also highlighted the AAFP’s free-to-use Neighbor Navigator tool, which allows providers to insert a zip code and receive a list of nearby programs for SDOH like food insecurity.

“That’s a great place to start because it can be overwhelming to a practice to say, ‘Oh my goodness, how do I come up with all of these [resources]?’” he said. “Having a go-to place that will give you the other people who are working on that and letting you connect [patients] to the resources that they need is the most important part.”

Addressing adverse SDOH in EDs

Like PCPs, emergency medicine physicians should understand what social care emergencies are, and which ones are “remediable,” Arbour said.

“If someone has nowhere to sleep tonight, that should activate emergency shelter,” she explained. “That isn’t something that’s accessible for everyone in our society, but it is something that should be pursued.”

She added that there are specific domains of need “where there is universal access and entitlement or protections in place, and I think that both PCPs and emergency physicians should be regularly updated and trained and refreshed on what those are.”

For example, for a patient who is facing housing insecurity and needs to access available resources, “they have to be documented as unhoused or homeless, and a doctor’s note that verifies that is helpful,” Arbour said.

Kohl also noted that emergency medicine physicians should think ahead and understand the factors that may bring a patient back into the ED.

“I think that what you’ll find is a large portion of the things that drive people back to the ED aren’t pathophysiology or a problem with the treatment,” he said. “It’s the social environment that somebody goes back into that doesn’t allow them to be successful.”

Local solutions

The kinds of community resources and tools that providers and health systems are missing can vary depending on their current level of investment and how much progress they have made in addressing SDOH so far.

“As health care delivery systems are trying to build approaches to identify and address SDOH, they’re doing it in all sorts of different ways,” Arbour explained. “We do nine domains. That’s big.”

In comparison, other health systems that are just starting to focus on adverse SDOH may choose a single domain on which to concentrate their efforts.

“For example, [Stanford Medicine Children’s Health] is starting with food insecurity, and they’re starting with food insecurity because they have a single food bank that they have a partnership with,” Arbour noted. “They were able to build a direct referral within the electronic health record for anyone who screened positive for food insecurity, and that will connect them directly to a source of food, which is great.”

Arbour stressed that the problems that patients are facing that require community resources in the first place must have local solutions.

“When I have a patient who screens positive for some social need, having somebody from Timbuktu call my patient to talk about something that was found on an online database is less likely to help that patient find and access a high-quality resource than the system we’ve built, which is a system of tiered support with local people who know the local resource,” she explained.

Arbor also emphasized the importance of being a good partner to resources and programs.

“We have to be willing and ready to listen to our community partners,” she said.

Ultimately, physicians should strive to identify patients with adverse SDOH, even amid a busy work schedule, Kohl said.

“It’s easy to think, ‘I’ll have a social worker deal with this, or I’ll have somebody else do it.’ But to be effective as a physician, you’ve got to have that relationship with the patient and be able to identify [the problem],” he said. “We may not be able to solve the problems. But the fact is that we can identify it, we can call it out, and we can connect you with resources — [it] is the same that we do for any other disease process.”

References:

• Americans see unmet needs in housing, food, social connection as a growing concern and significant barrier to health. https://www.prnewswire.com/news-releases/americans-see-unmet-needs-in-housing-food-social-connection-as-a-growing-concern-and-significant-barrier-to-health-300861235.html. Published June 4, 2019. Accessed March 27, 2024.
• Are you going hungry? Pediatricians are adding food insecurity to their health checks. https://stanmed.stanford.edu/tackling-social-challenges-good-health/#food. Accessed April 2, 2024.
• Frequently asked questions about screening for food insecurity. https://healthier.stanfordchildrens.org/en/frequently-asked-questions-about-screening-for-food-insecurity/. Published Feb. 3, 2023. Accessed April 2, 2024.
• Key statistics & graphics. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics/. Accessed March 27, 2024.
• Neighborhood navigator. https://www.aafp.org/family-physician/patient-care/the-everyone-project/neighborhood-navigator.html. Accessed March 26, 2024.
• Social determinants of health. https://health.gov/healthypeople/priority-areas/social-determinants-health. Accessed March 26, 2024.
• The PRAPARE screening tool. https://prapare.org/the-prapare-screening-tool/. Accessed March 26, 2024.
• Three tools for screening for social determinants of health. https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/social_determinants.html. Accessed March 26, 2024.
• Your current life situation survey. https://sirenetwork.ucsf.edu/tools-resources/resources/your-current-life-situation-survey. Accessed March 26, 2024.

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April 12, 2024

2 min read

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Key takeaways:

• Preoperative antibiotic therapy significantly decreased operative culture yield in patients with native joint septic arthritis.
• Additional antibiotics and earlier initiation also led to decreases.

Preoperative antibiotic exposure led to a significant decrease in microbiologic yield of operative cultures among patients with native joint septic arthritis, researchers found.

These findings, which were initially reported at the Musculoskeletal Infection Society Annual Meeting, were recently published in Clinical Infectious Diseases.

Patients with native joint septic arthritis given preoperative antibiotic exposure had a significant decrease in microbiologic yield of operative cultures. Image: Adobe Stock.

“We noticed that there was an existing knowledge gap in the literature regarding the effect of preoperative antibiotic therapy on operative culture yield for native joint septic arthritis (NJSA) diagnosis and given this,” Ryan B. Khodadadi, MD, chief fellow in Mayo Clinic’s division of public health, infectious diseases, and occupational medicine, told Healio.

“We were hoping to learn more about the potential impact of antibiotic therapy on diagnostic accuracy for diagnosis of this condition,” he said.

The researchers retrospectively reviewed cases of NJSA among adult patients who underwent surgery at four Mayo Clinic facilities between 2012 and 2021. According to the study, they analyzed the effect of preoperative antibiotics on operative culture (OC) yield through a paired analysis of preoperative culture (POC) and OC results using logistic regression.

In total, 299 patients with NJSA affecting 321 joints were included in the study. The study showed that yield significantly decreased among the patients who received preoperative antibiotics, with 68% POC being positive before surgery and 57.1% OC remaining positive after antibiotic exposure (P < .001).

Among patients who did not receive preoperative antibiotics, there was a nonsignificant increase in culture positivity from 60.9% at POC to 67.4% at OC (P = .244).

Logistic regression analyses showed that preoperative antibiotic exposure was more likely to decrease positive OCs compared with nonexposure (OR = 2.12; 95% CI, 1.24-3.64). These patients also had a lower OC yield when given additional antibiotic doses (P < .001) and earlier antibiotic initiation (P < .001).

Based on these findings, Khodadadi said that this study emphasizes the importance of a “thoughtful stepwise approach” to antibiotic therapy and surgical management in NJSA, taking into account both the clinical urgency of early treatment and the potential impact on diagnostic accuracy.

“Given the significant decrease in microbiologic yield of operative cultures among patients exposed to antibiotics, we would recommend obtaining peripheral blood cultures and performing a diagnostic arthrocentesis prior to initiation of antibiotics to improve culture yield and inform the choice of definitive antibiotic therapy,” Khodadadi said. “From there, we would recommend administration of empiric preoperative antibiotic therapy followed by surgical joint evacuation.”

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Disclosures:
Khodadadi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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