"Prehabilitation" for Pediatric Patients With Cancer Before Undergoing Hematopoietic Stem Cell Transplantation.

Hematopoietic stem cell transplantation (HSCT) is associated with significant physical debility. Studies have suggested that physical activity can improve endurance and strength. However, studies have not yet investigated "prehabilitation," exercise before HSCT, to improve functional outcomes. We describe the impact of exercise therapy on physical debility in children undergoing HSCT to inform the implementation of prehabilitation. This review was conducted through a search of the electronic database PubMed. Articles included were those with original research, including randomized control trials, prospective studies, case controls, and retrospective studies. Eleven of the 191 resulting studies met our review criteria. None focused on prehabilitation, but instead on interventions during HSCT. Ten studies showed improvement or maintenance of strength, endurance, stretching, or aerobic fitness. This review shows that exercise therapy can positively affect outcomes in patients undergoing HSCT. Further investigations are needed to determine whether prehabilitation has better results than concurrent exercise.

Electronic Dashboard to Improve Outcomes in Pediatric Patients With Type 1 Diabetes Mellitus.

BACKGROUND AND OBJECTIVES: Incidence of type 1 diabetes mellitus (T1DM) is increasing, and these patients often have poor glycemic control. Electronic dashboards summating patient data have been shown to improve patient outcomes in other conditions. In addition, educating patients on T1DM has shown to improve glycated hemoglobin (A1C) levels. We hypothesized that using data from the electronic dashboard to monitor defined diabetes management activities to implement population-based interventions would improve patient outcomes. METHODS: Inclusion criteria included patients aged 0 to 18 years at Phoenix Children's Hospital with T1DM. Patient data were collected via the electronic dashboard, and both diabetes management activities (A1C, patient admissions, and visits to the emergency department) and patient outcomes (patient education, appointment compliance, follow-up after hospital admission) were analyzed. RESULTS: This study revealed that following implementation of the electronic dashboard, the percentage of patients receiving appropriate education increased from 48% to 80% (Z-score = 23.55, P < .0001), the percentage of patients attending the appropriate number of appointments increased from 50% to 68.2%, and the percentage of patients receiving follow-up care within 40 days after a hospital admission increased from 43% to 70%. The median A1C level decreased from 9.1% to 8.2% (Z-score = -6.74, P < .0001), and patient admissions and visits to the emergency department decreased by 20%. CONCLUSIONS: This study shows, with the implementation of an electronic dashboard, we were able to improve outcomes for our pediatric patients with T1DM. This tool can be used at other institutions to improve care and outcomes for pediatric patients with T1DM and other chronic conditions.