The essence of healthcare records: embedded electronic health record system microblogging functionality for patient care narrative.

INTRODUCTION: Electronic health record (EHR) systems capture information relating to patients across many specialties but can be complex, making rapid evaluation and communication of current important issues difficult. METHODS: As part of a children's hospital EHR implementation, we developed and implemented an embedded microblogging platform to allow users to provide a short summary of main issues or actions relating to the encounter, 'Essence' capturing the essence of the interaction. We reviewed usage by specialty and user type over a 1-year period. RESULTS: Ninety-one thousand, nine-hundred and fifty Essence entries were committed across 49 specialty areas during a 12-month period, April 2019 - April 2020. The specialties with greatest usage were cardiology, neurosurgery, intensive care, respiratory medicine and neurology, with 70% of entries by nursing staff. The median number of words used per entry was 17 words (range 1-120; mean 20.7), and microblogs were mainly used to describe actions, events or planned care. Manual content analysis of 200 representative entries demonstrated categories of importance (including clinical status, treatment plan, investigations, procedures and diagnoses) suggesting appropriate clinical utility. CONCLUSION: Incorporation of an embedded EHR microblogging platform to capture key interactions with healthcare professionals represents a novel approach to coordinating care communication and is widely used across specialties, especially by nursing staff.

Dysphonia and dysphagia consequences of paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS).

IMPORTANCE: Paediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV-2 (PIMS-TS) is a novel disease first identified in 2020. Recent cohort studies have described the complex presentation and symptomatology. This paper provides detailed description of the dysphagia and dysphonia symptoms, management, and outcome. OBJECTIVE: To describe dysphagia and dysphonia in PIMS-TS. DESIGN: Retrospective cohort study. SETTING: Single tertiary and quaternary children's hospital. PARTICIPANTS: All 50 children treated for paediatric multisystem inflammatory disease between April and June 2020 were included in this study. MAIN OUTCOME(S) AND MEASURE(S): Dysphonia: GRBAS Perceptual Severity Scores, Vocal Handicap Index scores and the Vocal Tract Discomfort Scale. Dysphagia: Functional Oral Intake Scale. RESULTS: Fifty children met the diagnostic criteria for PIMS-TS. 33 (66%) were male. Median age was 10 years (range: 1-17). 36 (72%) were of Black, Asian or minority ethnic background. Nine (18%) required specialist assessment and management of dysphagia and/or dysphonia. Five (55%) were male with a median age of 9 years 7 months (range: 1-15 years). Symptoms typically resolved within three months. Two children presented with persisting dysphonia three months post-presentation. Neurological, inflammatory, and iatrogenic causes of dysphagia and dysphonia were identified. CONCLUSIONS AND RELEVANCE: Dysphonia and dysphagia are present in children with PIMS-TS. Further data is required to understand pathophysiology, estimate incidence, and determine prognostic factors. This preliminary data highlights the need for dysphagia and dysphonia screening and timely referral for specialist, multidisciplinary assessment and treatment to ensure short-term aspiration risk is managed and long-term, functional outcomes are optimised.

Cochlear implantation: An assessment of quality and readability of web-based information aimed at patients.

OBJECTIVES: Patients should have access to high-quality health information websites on which to base their decision-making. There are concerns regarding the accuracy and quality of some health websites. We aimed to objectively measure website quality related to cochlear implantation. METHODS: Selected patient-information websites were scored, depending on how highly they ranked on search engines and if they were ranked on more than one of the search engines used. The top 40 websites from three major search engines were analysed. The quality of each website was scored using the DISCERN tool and the readability was scored using the Flesch-Kincaid reading ease and the Gunning-Fog index. RESULTS: The average Flesch-Kincaid score was 49.7, giving an average reading age of a 15-17 years old, and the average Gunning-fog score was 13.1, which equals that of an 18 years old. CONCLUSION: Internet-based information regarding cochlear implantation is of varied quality and is written above the expected reading level of an average person.

Cochlear re-implant rates in children: 20 years experience in a quaternary paediatric cochlear implant centre.

The aim of this study is to determine the incidence and causes for cochlear explantation/re-implantation in children as a retrospective case review in a Quaternary paediatric Cochlear Implant (CI) Centre. The subjects included in the study were Paediatric CI patients requiring cochlear explantation/re-implantation. Outcome measurements were incidence and aetiology of device explantation/re-implantation. Patient age at implantation, aetiology of deafness, CI manufacturer, and timing of explantation/re P implantation were the independent variables. 778 paediatric cochlear implants were performed in 653 children between 1992 and January 2013. There were a total of 40 (5.1%) failed implants in 38 patients. The most common reason for explantation was device failure in 22 (2.8%). Risk factors for device failure were known manufacturing defect/device recall. Medical/surgical issues accounted for 18 (2.3%) implant failures. The mean time to explantation was 3 years 10 months. The incidence of explantation/re-implantation in our paediatric cochlear implant population is comparable to other published studies. The most common reason for explantation was device failure, however, the aetiology of deafness, in particular meningitis, does not appear to increase the risk of explantation as described in previous series.

Stem-cell-based, tissue engineered tracheal replacement in a child: a 2-year follow-up study.

BACKGROUND: Stem-cell-based, tissue engineered transplants might offer new therapeutic options for patients, including children, with failing organs. The reported replacement of an adult airway using stem cells on a biological scaffold with good results at 6 months supports this view. We describe the case of a child who received a stem-cell-based tracheal replacement and report findings after 2 years of follow-up. METHODS: A 12-year-old boy was born with long-segment congenital tracheal stenosis and pulmonary sling. His airway had been maintained by metal stents, but, after failure, a cadaveric donor tracheal scaffold was decellularised. After a short course of granulocyte colony stimulating factor, bone marrow mesenchymal stem cells were retrieved preoperatively and seeded onto the scaffold, with patches of autologous epithelium. Topical human recombinant erythropoietin was applied to encourage angiogenesis, and transforming growth factor ß to support chondrogenesis. Intravenous human recombinant erythropoietin was continued postoperatively. Outcomes were survival, morbidity, endoscopic appearance, cytology and proteomics of brushings, and peripheral blood counts. FINDINGS: The graft revascularised within 1 week after surgery. A strong neutrophil response was noted locally for the first 8 weeks after surgery, which generated luminal DNA neutrophil extracellular traps. Cytological evidence of restoration of the epithelium was not evident until 1 year. The graft did not have biomechanical strength focally until 18 months, but the patient has not needed any medical intervention since then. 18 months after surgery, he had a normal chest CT scan and ventilation-perfusion scan and had grown 11 cm in height since the operation. At 2 years follow-up, he had a functional airway and had returned to school. INTERPRETATION: Follow-up of the first paediatric, stem-cell-based, tissue-engineered transplant shows potential for this technology but also highlights the need for further research. FUNDING: Great Ormond Street Hospital NHS Trust, The Royal Free Hampstead NHS Trust, University College Hospital NHS Foundation Trust, and Region of Tuscany.