Microbiota of De-Novo Pediatric IBD : Increased Faecalibacterium Prausnitzii and Reduced Bacterial Diversity in Crohn's But Not in Ulcerative Colitis

ACKNOWLEDGMENTS We are grateful for the expertise of our sequencing provider NewGene and in particular for the support and help of Dr Jonathan Coxhead.Mrs Karen McIntyre and Dr Dagmar Kastner were invaluable in identifying patients for recruitment in Dundee. Mrs Ann Morrice provided administrative support in Aberdeen. Dr Paul Henderson gave helpful comments on the manuscript. We appreciate the generosity of the families who freely gave their time and samples to make this study possible and the theatre staff of all centers who allowed time for sample collection during busy endoscopy lists.Peer reviewedPublisher PD

Efficacy and Outcomes of Faecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection in Children with Inflammatory Bowel Disease

BACKGROUND: Children with inflammatory bowel disease [IBD] are disproportionally affected by recurrent Clostridioides difficile infection [rCDI]. Although faecal microbiota transplantation [FMT] has been used with good efficacy in adults with IBD, little is known about outcomes associated with FMT in paediatric IBD. METHODS: We performed a retrospective review of FMT at 20 paediatric centres in the USA from March 2012 to March 2020. Children with and without IBD were compared with determined differences in the efficacy of FMT for rCDI. In addition, children with IBD with and without a successful outcome were compared with determined predictors of success. Safety data and IBD-specific outcomes were obtained. RESULTS: A total of 396 paediatric patients, including 148 with IBD, were included. Children with IBD were no less likely to have a successful first FMT then the non-IBD affected cohort [76% vs 81%, p = 0.17]. Among children with IBD, patients were more likely to have a successful FMT if they received FMT with fresh stool [p = 0.03], were without diarrhoea prior to FMT [p = 0.03], or had a shorter time from rCDI diagnosis until FMT [p = 0.04]. Children with a failed FMT were more likely to have clinically active IBD post-FMT [p = 0.002] and 19 [13%] patients had an IBD-related hospitalisation in the 3-month follow-up. CONCLUSIONS: Based on the findings from this large US multicentre cohort, the efficacy of FMT for the treatment of rCDI did not differ in children with IBD. Failed FMT among children with IBD was possibly related to the presence of clinically active IBD

Non-Invasive Mapping of the Gastrointestinal Microbiota Identifies Children with Inflammatory Bowel Disease

Background: Pediatric inflammatory bowel disease (IBD) is challenging to diagnose because of the non-specificity of symptoms; an unequivocal diagnosis can only be made using colonoscopy, which clinicians are reluctant to recommend for children. Diagnosis of pediatric IBD is therefore frequently delayed, leading to inappropriate treatment plans and poor outcomes. We investigated the use of 16S rRNA sequencing of fecal samples and new analytical methods to assess differences in the microbiota of children with IBD and other gastrointestinal disorders. Methodology/Principal Findings: We applied synthetic learning in microbial ecology (SLiME) analysis to 16S sequencing data obtained from i) published surveys of microbiota diversity in IBD and ii) fecal samples from 91 children and young adults who were treated in the gastroenterology program of Children’s Hospital (Boston, USA). The developed method accurately distinguished control samples from those of patients with IBD; the area under the receiver-operating-characteristic curve (AUC) value was 0.83 (corresponding to 80.3% sensitivity and 69.7% specificity at a set threshold). The accuracy was maintained among data sets collected by different sampling and sequencing methods. The method identified taxa associated with disease states and distinguished patients with Crohn’s disease from those with ulcerative colitis with reasonable accuracy. The findings were validated using samples from an additional group of 68 patients; the validation test identified patients with IBD with an AUC value of 0.84 (e.g. 92% sensitivity, 58.5% specificity). Conclusions/Significance: Microbiome-based diagnostics can distinguish pediatric patients with IBD from patients with similar symptoms. Although this test can not replace endoscopy and histological examination as diagnostic tools, classification based on microbial diversity is an effective complementary technique for IBD detection in pediatric patients.Natural Sciences and Engineering Research Council of Canada (Award NSERC PGS D)National Institutes of Health (U.S.) (1-R21-A1084032-01A1

The Need for Artificial Intelligence in Digital Therapeutics

Digital therapeutics is a newly described concept in healthcare which is proposed to change patient behavior and treat medical conditions using a variety of digital technologies. However, the term is rarely defined with criteria that make it distinct from simply &lt;i&gt;digitized&lt;/i&gt;versions of traditional &lt;i&gt;therapeutics&lt;/i&gt;. Our objective is to describe a more valuable characteristic of digital therapeutics, which is distinct from traditional medicine or therapy: that is, the utilization of artificial intelligence and machine learning systems to monitor and predict individual patient symptom data in an adaptive clinical feedback loop via digital biomarkers to provide a precision medicine approach to healthcare. Artificial intelligence platforms can learn and predict effective interventions for individuals using a multitude of personal variables to provide a customized and more tailored therapy regimen. Digital therapeutics coupled with artificial intelligence and machine learning also allows more effective clinical observations and management at the population level for various health conditions and cohorts. This vital differentiation of digital therapeutics compared to other forms of therapeutics enables a more personalized form of healthcare that actively adapts to patients’ individual clinical needs, goals, and lifestyles. Importantly, these characteristics are what needs to be emphasized to patients, physicians, and policy makers to advance the entire field of digital healthcare.</jats:p

Using mobile virtual reality to enhance medical comprehension and satisfaction in patients and their families

Patients are typically debriefed by their healthcare provider after any medical procedure or surgery to discuss their findings and any next steps involving medication or treatment instructions. However, without any medical or scientific background knowledge, it can feel overwhelming and esoteric for a patient to listen to a physician describe a complex operation. Instead, providing patients with engaging visuals and a virtual reality (VR) simulation of their individual clinical findings could lead to more effective transfer of medical knowledge and comprehension of treatment information. A newly developed VR technology is described, called HealthVoyager, which is designed to help facilitate this knowledge transfer between physicians and patients. The platform represents a customizable, VR software system utilizing a smartphone or tablet computer to portray personalized surgical or procedural findings as well as representations of normal anatomy. The use of such technology for eliciting medical understanding and patient satisfaction can have many practical and clinical applications for a variety of disease states and patient populations.</jats:p

Identifying patterns in administrative tasks through structural topic modeling: A study of task definitions, prevalence, and shifts in a mental health practice’s operations during the COVID-19 pandemic

Abstract Objective This case study illustrates the use of natural language processing for identifying administrative task categories, prevalence, and shifts necessitated by a major event (the COVID-19 [coronavirus disease 2019] pandemic) from user-generated data stored as free text in a task management system for a multisite mental health practice with 40 clinicians and 13 administrative staff members. Materials and Methods Structural topic modeling was applied on 7079 task sequences from 13 administrative users of a Health Insurance Portability and Accountability Act–compliant task management platform. Context was obtained through interviews with an expert panel. Results Ten task definitions spanning 3 major categories were identified, and their prevalence estimated. Significant shifts in task prevalence due to the pandemic were detected for tasks like billing inquiries to insurers, appointment cancellations, patient balances, and new patient follow-up. Conclusions Structural topic modeling effectively detects task categories, prevalence, and shifts, providing opportunities for healthcare providers to reconsider staff roles and to optimize workflows and resource allocation. </jats:sec

Outcomes of End-User Testing of a Care Coordination Mobile App With Families of Children With Special Health Care Needs: Simulation Study

BackgroundCare for children with special health care needs relies on a network of providers who work to address the medical, behavioral, developmental, educational, social, and economic needs of the child and their family. Family-directed, manually created visual depictions of care team composition (ie, care mapping) and detailed note-taking curated by caregivers (eg, care binders) have been shown to enhance care coordination for families of these children, but they are difficult to implement in clinical settings owing to a lack of integration with electronic health records and limited visibility of family-generated insights for care providers. Caremap is an electronic health record–integrated digital personal health record mobile app designed to integrate the benefits of care mapping and care binders. Currently, there is sparse literature describing end-user participation in the co-design of digital health tools. In this paper, we describe a project that evaluated the usability and proof of concept of the Caremap app through end-user simulation. ObjectiveThis study aimed to conduct proof-of-concept testing of the Caremap app to coordinate care for children with special health care needs and explore early end-user engagement in simulation testing. The specific aims included engaging end users in app co-design via app simulation, evaluating the usability of the app using validated measures, and exploring user perspectives on how to make further improvements to the app. MethodsCaregivers of children with special health care needs were recruited to participate in a simulation exercise using Caremap to coordinate care for a simulated case of a child with complex medical and behavioral needs. Participants completed a postsimulation questionnaire adapted from 2 validated surveys: the Pediatric Integrated Care Survey (PICS) and the user version of the Mobile Application Rating Scale (uMARS). A key informant interview was also conducted with a liaison to Spanish-speaking families regarding app accessibility for non–English-speaking users. ResultsA Caremap simulation was successfully developed in partnership with families of children with special health care needs. Overall, 38 families recruited from 19 different US states participated in the simulation exercise and completed the survey. The average rating for the survey adapted from the PICS was 4.1 (SD 0.82) out of 5, and the average rating for the adapted uMARS survey was 4 (SD 0.83) out of 5. The highest-rated app feature was the ability to track progress toward short-term, patient- and family-defined care goals. ConclusionsInternet-based simulation successfully facilitated end-user engagement and feedback for a digital health care coordination app for families of children with special health care needs. The families who completed simulation with Caremap rated it highly across several domains related to care coordination. The simulation study results elucidated key areas for improvement that translated into actionable next steps in app development

Outcomes of End-User Testing with families of CYSHCN on a Care Coordination Mobile App: A Simulation Study (Preprint)

BACKGROUND Care for children and youth with special healthcare needs (CYSHCN) relied on a network of providers who work to address the medical, behavioral, developmental, educational, family support, social, and economic needs of the child and family. Family-directed, manually created visual depictions of care team composition (i.e. care mapping) and detailed notetaking curated by caregivers (e.g. care binders) have been shown to enhance care coordination (CC) for families of CYSHCN, but are difficult to implement in clinical settings due to lack of integration with electronic health records (EHR) and limited visibility of family generated insights for care providers. Digital health tools are a promising solution to address this. Caremap is an EHR-integrated digital personal health record mobile application designed to integrate the benefits of care mapping and care binders. Currently, there is sparse literature describing end-user participation in the co-design of digital health tools that support care coordination for families of CYSHCN. In this paper, we describe a project that evaluated app usability and proof-of-concept through end-user simulation. OBJECTIVE The goal of this study was to conduct proof-of-concept of the Caremap app to coordinate care for CYSHCN. Specific aims include 1) to engage end-users in app co-design via app simulation; 2) to evaluate the useability of the app using validated measures; and 3) to explore user perspectives on how to make further improvements to the app using qualitative and quantitative data collection. METHODS In partnership with Family Voices, a national advocacy group for families of CYSHCN, caregivers of CYSHCN were recruited and underwent a virtual simulation exercise using Caremap to coordinate care for a simulated case of a child with complex medical and behavioral needs. Caregivers completed a post-simulation questionnaire adapted from two validated surveys: the Pediatric Integrated Care Survey (PICS) and the User Version of the Mobile Application Rating Scale (uMARS). In addition, a key informant interview was conducted with a liaison to Spanish-speaking families of CYSHCN regarding app accessibility for non-English speaking users. RESULTS A Caremap simulation was successfully developed in partnership with families of CYSHCN. 38 families recruited from 19 different states participated in the simulation exercise and completed the survey. Average rating for the adapted PICS survey was 4.1/5 (range: 1-5), and average rating for the adapted uMARS survey was 4/5(range: 1-5). The highest rated app feature was the ability to track progress toward short-term, patient/ family defined care goals. CONCLUSIONS Virtual simulation successfully facilitated end-user engagement and feedback on the usability and functionality of a digital health care coordination app for families of CYSHCN. Families who completed simulation with Caremap rated the app highly across several domains for CC. Simulation study results also elucidated key areas for improvement that translated to actionable next steps in application development. </sec