Tag Archives: allergies.

Electronic health records: Quick access to patient’s records improves patient care

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When a patient gets transferred from a hospital to a nearby specialist or rehabilitation facility, it is often difficult for personnel at the new facility to access the patient’s electronic health records – which includes important patient-specific information such as their medication history and allergies. This lack of electronic compatibility often leads to wasteful and expensive duplication of tests, X-rays and paperwork that can interfere with the treatment of patients.

A recent study at the University of Missouri highlights how the use of electronic health records have resulted better quality of care – which can direct the next steps of government programs to ensure hospitals use electronic health records in a way that promotes interoperability, or the ability for various health care organizations to quickly access a patient’s records, reduce waste and speed up decision-making to improve patient health outcomes.

So far, the adoption and implementation of electronic health records has been a bumpy road, said Kate Trout, assistant professor in the MU School of Health Professions and lead author on the study. Electronic health records have widely been cited in research literature as the most cumbersome technology ever implemented in the health care industry.

“They have the potential to be very helpful, but in practice they tend to be very disruptive because it’s time consuming to train personnel how to use them. They’re expensive, and there’s always new complicated updates and new forms that come out, and there is often a lack of interoperability for the data to be shared among different health care organizations,” Trout said. “Given the massive national investments, we wanted to see if electronic health records are being utilized in a meaningful way to promote interoperability and ultimately improve quality of care.”

electronic health records

electronic health records/University of Missouri

More than $30 billion has been invested by the federal government in the adoption and use of electronic health records by health care organizations in an attempt to improve the quality of care delivered to patients.

In 2011, Centers for Medicare and Medicaid established the “Meaningful Use” program – now known as the “Promoting Interoperability Program” – which offers financial incentives to health care providers who effectively utilize electronic health records in a way that promotes information sharing, public health reporting and interoperability.

Trout analyzed the impact of electronic health records on mortality rates for patients with various medical procedures and conditions. More than 5 million patients in 300 U.S. hospitals were included in the study, which merged large datasets from the electronic health records, the American Hospital Association and Centers for Medicare and Medicaid.

Three main categories emerged:

  1. hospitals that meet the “Meaningful Use” requirements with their electronic health records,
  2. hospitals that fully implement electronic health records but not in a way that meets the “Meaningful Use” requirements, and
  3. hospitals that have either none or only partially implemented electronic health records.

Trout found that the hospitals that meet the “Meaningful Use” requirements were able to improve quality of care and reduce patient mortality rates to a greater extent than hospitals in the other two groups. While the results show some optimism, Trout cautions that more still needs to be done, including the need to analyze the impact of interoperability and advanced electronic health record functions on quality of care.

“This research highlights the importance of using electronic health records in a way that promotes interoperability to streamline processes, speed up decision-making, reduce wasted time and ultimately improve patient health outcomes,” Trout said. “Ideally, the United States could implement one standardized electronic health records system for everyone to ensure compatibility, so policy makers can hopefully benefit from this research.”

Trout added that with the use of data mining and analytics, electronic health records can be better used going forward to potentially identify patient characteristics that put them at higher risks for possible infections or other conditions.

healthcare

“With this information, are there alerts we can put in after a surgery to ensure we follow up at critical points in time?” Trout said. “Are there certain patient populations that we can use the data to catch them earlier and make sure we give them extra care and not just put them through the same routine protocols as everyone else? That is how we move away from only focusing on implementing the technology and progress toward encouraging innovative ideas that ultimately improve patient health outcomes.”

Trout said this research can be particularly useful for rural hospitals that historically have less resources and lag behind their urban counterparts in adopting health technology like telehealth and electronic health records. There have been many closures of rural hospitals, an issue that has been worsened by the COVID-19 pandemic, and rural patients tend to have more co-morbidities and worse health outcomes.

“I am passionate about helping vulnerable, underserved populations, and our personal health is often tied to where we live and various social determinants of health,” Trout said. “Those ideas are not incorporated into our clinical data yet, but they should be going forward. My overall goal is to harness the data in a way that we can hopefully start to spend less and get more.”

Infants, young children finally get relief from eczema’s terrible itch, scratching

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· More than half of children treated had at least a 75% reduction in signs of eczema and itch
· Kids sleep through night for first time instead of scratching
· Parents see children’s personalities change as they are able to lead a normal life.

Eczema, also known as atopic dermatitis, is a chronic inflammatory skin disorder characterized by red, dry, often oozing skin and itch that can profoundly affect the lives of affected patients and their families.

An estimated 19% or more of all children under 6 years of age have eczema and 85 to 90% of individuals affected overall with eczema have the onset of disease during the first five years of life.

The children’s debilitating itch leads to sleep disturbance, poor neurocognitive development and, on average, a full night of sleep lost per week.

CHICAGO — The first study to treat moderate-to-severe eczema in infants and children 6 months to 5 years old with a biologic drug (monoclonal antibody) rather than immune-suppressing medications shows the drug was highly effective in reducing the signs and symptoms of moderate-to-severe eczema, report researchers involved in a new multi-site international phase III study led by Northwestern Medicine.

A 16-week course of dupilumab, a medication that targets a key immune pathway in allergies, resulted in more than half the children having at least a 75% reduction in signs of eczema and highly significant reductions in itch with improved sleep.

This is the first large-scale, randomized, placebo-controlled trial of a monoclonal antibody in any skin disease, including eczema, in children as young as 6 months. The study, which included 31 sites in Europe and North America, will be published Sept. 15 in The Lancet.

“Preschoolers who are constantly scratching, awake multiple times a night with their parents, irritable and markedly curtailed in their ability to do what other children their ages can do improved to the extent that they sleep through the night, change their personalities and have a normal life — as babies and children should,” said lead study author Dr. Amy Paller, chair of dermatology at Northwestern University Feinberg School of Medicine and an attending physician at Ann & Robert H. Lurie Children’s Hospital of Chicago.

“The ability to take this drug will significantly improve the quality of life for infants and young children who suffer tremendously with this disease,” Paller said. “Atopic dermatitis or eczema is so much more than just itchy skin. It is a devastating disease. The quality of life of severe eczema — not only for the child but also parents — is equivalent to many life-threatening diseases.”

As a result of this study, this medication is now available to infants and preschoolers as young as 6 months of age. It has “an outstanding safety profile” and does not even require any laboratory tests before starting the medication, Paller said.

Although one-half to two-thirds of young children with eczema have mild symptoms, which can be handled with steroid ointment and moisturizers, the other one-third or more have moderate-to-severe disease and require more aggressive management.

“Up to now, all we have had to treat more severe eczema is immune-suppressing medications, such as oral steroids, which we try to avoid in children, because they are associated with so many side effects and thus are not a preferred treatment for a chronic skin disease,” Paller said. “The potential long-term impact on the development of the immune system in young children is also of concern with these immunosuppressants.”

During the past few years, a new medication has become available called dupilumab, which is the first “biologic” drug to treat eczema in a targeted manner, meaning a narrow attack on just what scientists have found is causing the manifestations of the disease in skin. This medication was found to be effective and safe in studies with adults, then adolescents, then other school-aged children. 

“But the group in whom we worry the most about safety — those under 5 — had not been tested and were unable to get this medication,” Paller said.

The parent or a health care provider gives the child a monthly shot to administer the medication.

“The effect for most of these younger children is dramatic and at least as good as we’ve seen with the risky immunosuppressant medications,” Paller said.

Potential added benefit by treating associated allergies

This medication has also been shown to be effective for treating asthma, gastrointestinal manifestations of allergy and other allergy-mediated problems but is not yet approved for these indications in infants and young children.

In fact, 66% of children in this trial had developed their eczema during the first six months of life and, by the time of initiating the dupilumab, more than 80% had already developed at least one allergic disorder, such as asthma or food allergy.

“By treating more aggressively to calm the immune system activation in these young children with early, severe eczema, we may also reduce the risk of their developing a range of allergic problems, changing their life beyond improving eczema,” Paller said. “These associated allergic issues most often begin after the eczema starts.”

Children were randomized to receive either a placebo injection or the dupilumab (weight-based dosing) every four weeks for 16 weeks. Only children who were not responding adequately to topical medications were allowed to enroll, and they had to be of a high severity, even with the topical medications.

As a result of the study, Paller said, scientists and physicians can start to better understand the relationships between eczema and a variety of allergic disorders and can consider the possibility of using this medication for other disorders that affect these very young children.

The trial was sponsored by Regeneron Pharmaceuticals, Inc. and Sanofi, who jointly developed dupilumab.

Now go for painless tattoos that can be self-administered, say Researchers

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Instead of sitting in a tattoo chair for hours enduring painful punctures, imagine getting tattooed by a skin patch containing microscopic needles. Researchers at the Georgia Institute of Technology have developed low-cost, painless, and bloodless tattoos that can be self-administered and have many applications, from medical alerts to tracking neutered animals to cosmetics.

“We’ve miniaturized the needle so that it’s painless, but still effectively deposits tattoo ink in the skin,” said Mark Prausnitz, principal investigator on the paper. “This could be a way not only to make medical tattoos more accessible, but also to create new opportunities for cosmetic tattoos because of the ease of administration.”

Tattoos are used in medicine to cover up scars, guide repeated cancer radiation treatments, or restore nipples after breast surgery. Tattoos also can be used instead of bracelets as medical alerts to communicate serious medical conditions such as diabetes, epilepsy, or allergies.

Various cosmetic products using microneedles are already on the market — mostly for anti-aging — but developing microneedle technology for tattoos is new. Prausnitz, a veteran in this area, has studied microneedle patches for years to painlessly administer drugs and vaccines to the skin without the need for hypodermic needles.

tattoo/en.wikipedia.org

“We saw this as an opportunity to leverage our work on microneedle technology to make tattoos more accessible,” Prausnitz said. “While some people are willing to accept the pain and time required for a tattoo, we thought others might prefer a tattoo that is simply pressed onto the skin and does not hurt.”

Transforming Tattooing

Tattoos typically use large needles to puncture repeatedly into the skin to get a good image, a time-consuming and painful process. The Georgia Tech team has developed microneedles that are smaller than a grain of sand and are made of tattoo ink encased in a dissolvable matrix.

“Because the microneedles are made of tattoo ink, they deposit the ink in the skin very efficiently,” said Li, the lead author of the study.

In this way, the microneedles can be pressed into the skin just once and then dissolve, leaving the ink in the skin after a few minutes without bleeding.

Tattooing Technique

Although most microneedle patches for pharmaceuticals or cosmetics have dozens or hundreds of microneedles arranged in a square or circle, microneedle patch tattoos imprint a design that can include letters, numbers, symbols, and images. By arranging the microneedles in a specific pattern, each microneedle acts like a pixel to create a tattoo image in any shape or pattern.

The researchers start with a mold containing microneedles in a pattern that forms an image. They fill the microneedles in the mold with tattoo ink and add a patch backing for convenient handling. The resulting patch is then applied to the skin for a few minutes, during which time the microneedles dissolve and release the tattoo ink. Tattoo inks of various colors can be incorporated into the microneedles, including black-light ink that can only be seen when illuminated with ultraviolet light.

Prausnitz’s lab has been researching microneedles for vaccine delivery for years and realized they could be equally applicable to tattoos. With support from the Alliance for Contraception in Cats and Dogs, Prausnitz’s team started working on tattoos to identify spayed and neutered pets, but then realized the technology could be effective for people, too.

The tattoos were also designed with privacy in mind. The researchers even created patches sensitive to environmental factors such as light or temperature changes, where the tattoo will only appear with ultraviolet light or higher temperatures. This provides patients with privacy, revealing the tattoo only when desired.

A magnified view of a microneedle patch with green tattoo ink/photo:Georgia Tech

The study showed that the tattoos could last for at least a year and are likely to be permanent, which also makes them viable cosmetic options for people who want an aesthetic tattoo without risk of infection or the pain associated with traditional tattoos. Microneedle tattoos could alternatively be loaded with temporary tattoo ink to address short-term needs in medicine and cosmetics.

Microneedle patch tattoos can also be used to encode information in the skin of animals. Rather than clipping the ear or applying an ear tag to animals to indicate sterilization status, a painless and discreet tattoo can be applied instead.

“The goal isn’t to replace all tattoos, which are often works of beauty created by tattoo artists,” Prausnitz said. “Our goal is to create new opportunities for patients, pets, and people who want a painless tattoo that can be easily administered.”