Pediatric Rounds

NextGxDx, Seattle Children’s Partner on Genetic Test Utilization Management

In late June, Franklin-based NextGxDx announced a collaborative partnership with Seattle Children’s Hospital to develop a joint genetic test utilization management (UM) solution that could be used by children’s hospitals and pediatric practices across the country.

The collaboration will combine the hospital’s PLUGS UM – Pediatric Laboratory Utilization Guidance Services – program and its team of genetic testing experts with NextGxDx’s GeneConnect platform, a technology solution designed to bring highly specialized data and tools to help curb rising genetic testing send-out costs.

PLUGS helps provide practical resources, expert advice and a peer network for members to develop sustainable utilization management programs. GeneConnect leverages NextGxDx’s industry-leading database of genetic testing products and U.S.-based, CLIA-certified labs, called GeneSource™. GeneConnect offers hospitals administrative tools to further streamline the genetic test ordering process, including the ability to establish preferred reference lab relationships, track electronic orders and results, monitor physician/department test utilization, and easily compare testing options.

“The growth in the cost and complexity of genetic testing is overwhelming children’s hospitals and their ability to manage genetic test ordering,” said Michael Astion, MD, PhD, medical director in the Department of Laboratories at Seattle Children’s Hospital.

NextGxDx CEO Mark Harris, PhD, said his team is excited to develop a comprehensive UM solution that merges PLUGS’ clinical expertise and network with his company’s analytics, GeneConnect technology, and customer base of children’s hospitals. “We’re excited to support PLUGS’ mission to significantly reduce laboratory testing expenses while increasing the value of testing to patients,” Harris concluded.

Spoons Are for Dinner … Not Dosing

Mary Poppins might have famously claimed a spoonful of sugar helps the medicine go down, but the American Academy of Pediatrics would beg to differ.

Not only would the AAP not suggest downing raw sugar … the national organization wants pediatricians, nurse practitioners and pharmacists to rethink the way they describe dosing to parents. The AAP is urging prescribers and pharmacists to use only metric measurements on prescriptions, medication labels and dosing cups to ensure children receive the right amount of medicine. When dosing is described as a teaspoon or tablespoon, parents are apt to grab a spoon from the silverware drawer.

“Spoons come in many different sizes and are not precise enough to measure a child’s medication,” said pediatrician Ian Paul, MD, FAAP, lead author of the policy statement, “Metric Units and the Preferred Dosing of Orally Administered Liquid Medications,” which was released earlier this year. “For infants and toddlers, a small error – especially if repeated for multiple doses – can quickly become toxic.”

Each year more than 70,000 children visit emergency departments as a result of unintentional medication overdoses. “One tablespoon generally equals three teaspoons. If a parent uses the wrong size spoon repeatedly, this could easily lead to toxic doses,” Paul pointed out.

Research has shown common over-the-counter liquid medications for children often have metric dosing on the label but include a measuring device marked in teaspoons, or vice versa. Cutting down on caregiver confusion, a recent study demonstrated medication errors were significantly less common among parents using only mL-based dosing rather than teaspoons or tablespoons.

Exercising as a Teen Pays Off Later in Life

A new study by investigators at Vanderbilt University Medical Center and the Shanghai Cancer Institute in China has found women who exercised during their teen years were less likely to die from cancer and all other causes during middle-age and later in life.

Published online at the end of July in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association of Cancer Research, the study highlights the long term public health implications of making modifiable lifestyle choices among adolescents.

Lead author Sarah Nechuta, PhD, MPH, assistant professor of Medicine in the Vanderbilt Epidemiology Center, said, “Our results support the importance of promoting exercise participation in adolescence to reduce mortality in later life and highlight the critical need for the initiation of disease prevention early in life.”

Designed to ascertain potential associations between adolescent exercise and cancer, cardiovascular disease or other causes of death among women in middle age and later life, the study utilized data from the Shanghai Women’s Health Study — a large, ongoing prospective cohort study of 74,941 Chinese women between the ages of 40 and 70. The women, who enrolled in the study between 1996 and 2000, were interviewed at the onset about exercise during adolescence, including participation in team sports, as well as other adolescent lifestyle factors.

Participants were also asked about exercise during adulthood and other adult lifestyle factors and socioeconomic status, and participants were interviewed again every two to three years. Regular exercise was defined as occurring at least once a week for at least three continuous months. Women who reported regular adolescent exercise were also asked how many hours a week they participated and for how many years they had exercised regularly.

“In women, adolescent exercise participation, regardless of adult exercise, was associated with reduced risk of cancer and all-cause mortality,” explained Nechuta. Participation in team sports during the teen years also was associated with a reduced risk of cancer death later in life.

Investigators found that participation in exercise both during adolescence and recently as an adult was significantly associated with a 20 percent reduced risk of death from all causes, 17 percent for cardiovascular disease and 13 percent for cancer.

Children’s Healthcare of Atlanta First to Use Robotic Exoskeleton in Peds Rehab

This summer, Children’s Healthcare of Atlanta announced it had become the first pediatric hospital in America to offer patients enhanced neuro-rehabilitation services through the use of Ekso Bionics’ patented technology.

The hospital is incorporating Ekso—a wearable robotic exoskeleton— into its Center for Advanced Technology and Robotic Rehabilitation to continue offering the latest technology to help children and teens recover from injuries or disorders that have hindered their motor skills. The exoskeleton enables patients with lower-extremity paralysis or weakness to stand and walk with minimal assistance.

Using motors and sensors, along with the patient’s assistance with balance and positioning, the exoskeleton allows the child to walk over ground with an efficient, repetitive gait pattern, helping the body re-learn proper step pattern and weight shifts. The exoskeleton can provide therapists with immediate feedback from each step the patient takes showing how much work the machine is doing verses how much work the child is doing. Research has shown therapy with repetitive and random patterns helps the brain and spinal cord work together increasing strength, coordination, function and independence.

“Neuroplasticity is the adaptive capacity of the central nervous system to respond to repeated changes in stimuli, which it may do by reorganizing its structure, function or neural connections,” explained Joshua Vova, MD, medical director of Rehabilitation Services at Children’s Healthcare. “In effect, it can help patients recovering from stroke, brain injuries, and spinal cord injuries to learn to walk again, with a proper gait pattern which may help to minimize compensatory behaviors.”

Diagnosable Psychiatric Disorders in Children

In May, the Child Mind Institute released the organization’s first Children’s Mental Health Report, synthesizing evidence-based data on the prevalence of mental illness in children. The report found an estimated 17.1 million young people in the United States have, or have had, a diagnosable psychiatric disorder.

The report went on to say the majority of children aren’t being treated with estimates that 80 percent of children with diagnosable anxiety disorder, 60 percent of kids with diagnosable depression and 40 percent of adolescents diagnosed with ADHD not receiving treatment.

"The results are in and they are remarkable in that they defy the general public's perception of childhood mental illness," said Child Mind Institute Founder and President Harold Koplewicz, MD. "Many more kids than we realized struggle with mental illness, and nearly two thirds do not get treatment. This is a wake up call. Mental illness and learning disabilities are the common disorders of childhood."

The full report is available at http://childmind.org/speakup.