Despite clear guidelines for the care of patients with asthma, patient adherence to treatment remains suboptimal. This study by Bender and colleagues at Kaiser Permanente Colorado uses speech recognition software to create computer-generated telephone conversations to create reminders about medication use and prescription refills for families of children with asthma. Inhaled corticosteroid adherence was 25.4% higher in the intervention group than in the usual care group and was consistent in subgroups stratified by age, sex, race/ethnicity, body mass index, and disease-related characteristics. Apter’s related editorial discusses the implications of this technology for the treatment of other chronic illnesses.
This meta-analysis by Manja and colleagues systematically reviews evidence evaluating the effect of restricted vs liberal oxygen exposure on morbidity and mortality in extremely preterm infants. The meta-analysis concluded that, although infants cared for with a liberal oxygen target had significantly lower mortality before hospital discharge than infants cared for with a restricted oxygen target, the quality of evidence for this estimate of effect was low. In their accompanying editorial, Synnes and Miller discuss the reasons for the difficulty in identifying an optimal target including variability in measurement and in vulnerability to disease.
Continuing Medical Education and Journal Club
Diarrhea and pneumonia remain leading drivers of mortality among children worldwide, causing 2 million deaths in 2011. This study by Mohanan and colleagues aims to disentangle the low levels of health care practitioner knowledge from poor effort and delivery of care in rural India. Pediatric health care practitioners demonstrated low levels of knowledge during vignettes for childhood diarrhea and pneumonia and a large know-do gap in the practitioners’ treatment of childhood diarrhea. Tielsch’s related editorial discusses the need for better understanding and comprehensive strategies to address the know, do, and quality gaps across a range of practice environments.
In response to a 3.7-fold higher mortality rate in Latino children admitted to a pediatric intensive care unit, Anand and colleagues develop a multilevel intervention including education on culturally competent care, an increase in bilingual staff and interpreter services, outreach to the Latino community to remove barriers to care, and culturally sensitive end-of-life care discussions. As a result of the comprehensive program, the risk for mortality among Latino children dropped by 76%. Routine assessments should examine the effect of race/ethnicity on clinical outcomes of pediatric intensive care unit patients and ensure the delivery of linguistically supportive and culturally sensitive pediatric intensive care.
Highlights. JAMA Pediatr. 2015;169(4):297. doi:10.1001/jamapediatrics.2014.2118