Human papillomavirus vaccine series follow-through: comparison of four clinics in an academic medical center.

OBJECTIVE: The Centers for Disease Control & Prevention (CDC) recommends that the human papillomavirus (HPV) vaccine series be initiated at ages 11-12 years, but many children never follow-through with the series. By examining differences in clinic-specific vaccine series follow-through rates across four clinics, we aimed to identify best practices related to communication around the vaccine and pathways to follow-through. METHODS: We used the electronic medical record (EMR) to retrospectively analyze HPV vaccine follow-through at four clinic settings. We limited the sample to children ages 11-17 who received a dose of the vaccine series at any of the clinics between January 2015 and June 2018. The primary outcome was follow-through of the HPV vaccine series within 18 months of initiation. RESULTS: A total of 3,813 patients were included in this study, 29% of which followed through with the HPV vaccine series. There was significant variability of vaccine follow-through among the clinics (p<0.001), with the Med/Peds clinic having the highest rate of follow-through (32%). After adjusting for confounding variables, multivariable analysis found that Med/Peds and Family Medicine had higher odds of HPV vaccine series follow-through than the Pediatrics clinic. CONCLUSIONS: We found that the likelihood of vaccine series follow-through was highest when the series was started in the Med/Peds and Family Medicine clinics, compared to Pediatrics and Adolescent Medicine. These results suggest that further qualitative research is needed to understand what communication strategies are most effective at facilitating HPV vaccine uptake among adolescents, and how the most effective strategies can be shared among clinics.

Axillary Thermometry Demonstrates Greater Reliability Compared With Rectal Thermometry in Healthy Neonates.

Rectal thermometry (RT) is considered the gold standard for measuring temperature in newborns, despite increasing use of temporal artery thermometry (TT) and axillary thermometry (AT) methods. Few prospective studies compare RT, TT, and AT in a newborn nursery setting. To determine the accuracy and reliability of these methods, we enrolled 205 healthy, full-term newborns. TT displayed higher mean temperatures than RT by 0.25 °F (standard error [SE] = 0.04, P < .001). AT and RT measurements did not significantly differ, with their means differing only by 0.02 °F (SE = 0.04, P = .87). For reliability, RT measurements differed by 0.45 °F (SE = 0.03) in either direction of the models' predicted mean for each subject. AT and TT measurements varied much less from their predicted means 0.32 °F (SE = 0.02) and 0.34 °F (SE = 0.02), respectively (both P < .001). Assuming mean RT is correct, TT is less accurate than AT. RT showed poor reliability between measurements. AT is an accurate and reliable method of temperature screening in healthy neonates.

Prospective Assessment of Pill-Swallowing Ability in Pediatric Patients.

Difficulty with pill-swallowing ability (PSA) is common in children, yet formal evaluation is rare. The objective of this study was to prospectively evaluate and compare PSA of inpatient and outpatient children using the Pediatric Oral Medications Screener. We identified children aged 3 to 17 years admitted to a general or subspecialty pediatric service at a university hospital or outpatient clinic. Using the Pediatric Oral Medications Screener, patients were observed swallowing 3 different-sized placebo pills (5 mm tablet, 10 mm tablet, and 22 mm capsule), and subjective measures were assessed from parents and children. We analyzed 47 inpatients and 62 outpatients. Sixteen percent of patients could not swallow any pill, 11% only swallowed the small pill, 14% swallowed up to the medium pill, and 60% swallowed all formulations. After controlling for multiple factors, inpatients had superior PSA compared with outpatients ( P = .004). These results suggest targeted inpatient screening and widespread outpatient screening would likely identify children with reduced PSA.

A Prospective Comparison of Transcutaneous and Serum Bilirubin Within Brief Time Intervals.

The American Academy of Pediatrics recommends screening newborns ≥35 weeks' gestation with total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) to detect hyperbilirubinemia. Retrospective studies show TcB measurements strongly correlate with TSB; however, few prospective trials document this relationship. Furthermore, Dräger's newest TcB instrument, JM-105, remains unstudied in the United States. We measure TcB on foreheads and sternums of newborns using JM-105 and Bilichek devices within 30 minutes of TSB measurement. We find best overall TcB/TSB correlation with JM-105 on the sternum (mean TcB-TSB difference: -0.21 ± 1.15 mg/dL). Correlations between paired measurements for TcB on the sternum using JM-105 were 0.93 for all TSB levels (n = 178), 0.82 for TSB > 10 (n = 19), 0.69 for TSB > 12 (n = 11), and 0.52 for TSB > 15 (n = 6). TcB accuracy via JM-105 on the sternum significantly differed among races ( P < .001). For 5% of paired measurements, TcB with JM-105 on the sternum underestimated TSB by ≥2 mg/dL, and for <1% by ≥3 mg/dL.