On March 23, 2010, President Barack Obama of the United States of America, signed into law the Patient Protection and Affordable Care Act commonly referred to as health reform. This bill calls immediate attention to better coordinated care between providers of health care and ancillary services. While the health reform law is new, the concept of care coordination in the practical sense is familiar to several health and human service disciplines, such as behavioral healthcare, developmental disability systems of care, medical home models, disease management programs, case management programs, long term care Medicaid waivers, and large healthcare organizations. The aim of this study is to understand what consumers and families expect from care coordination programs and services, and how programs should be designed to ensure the most benefit
We will conduct a screening and direct assessment study in the general population in an area already undergoing monitoring by ADDM. Specifically, all 8-year-olds in a three county region of South Carolina (n=8,000) will be screened for ASD, and those found to be at risk for ASD will be invited to participate in an in-depth diagnostic assessment. Evidenced-based strategies will be implemented to maximize participation in both the screening and diagnostic phases of the study to improve the accuracy of the findings. ASD prevalence estimates will be calculated using the number of children aged 8 years residing in the study area as the denominator, and the number of children identified as cases as the numerator, with adjustments made for missing data from nonparticipants. Prevalence estimates will be provided using both traditional ADDM and SUCCESS methods. Factors contributing to
differences in ASD prevalence estimates by methodology (e.g. sex, race/ethnicity, SES, previous diagnoses, behaviors, degree of impairment, co-morbidities) will be examined. Additionally we will compare prevalence using the DSM-Iv and DSM-5 criteria.
Selection of the correct drug dose is the most important decision in assuring optimal pharmacotherapy. Defining an optimal regimen requires a clear understanding of the drug’s PK, pharmacodynamics (PD), and for methadone, pharmacogenomic profiles. Understanding these characteristics for drugs used in children is imperative to determine optimal dose regimens across the pediatric age continuum.
The goal of this study is to better understand single ventricle circulation after its final palliation, the Fontan procedure. Each specific aim of the project directly affects current knowledge and/or aids future research in this population. In regards to Aim1, a better understanding the impaired responses to stress in single ventricle circulation will help direct future research on ways to improve quality of life as well as help direct medical and surgical therapies in this population. In regards to Aim 2, the mechanism that leads to improved exercise capacity with PDE5 inhibition will be elucidated. These three aims all compliment the overall goal of understanding the mechanisms that lead to heart failure in this high risk population.
Children admitted to PICU with respiratory distress that require HFNC therapy will be eligible for entery. Patients will be randomly assigned into 2 arms of study. One arm will be standard oxygen therapy delivered via HFNC. Second arm will be HFNC with Heliox added. Patients heart rate, respiratory rate, O2 saturations, FIO2 and modified pulmonary Index score(mpis) distress score will be recorded at treatment intervals.
This is a Phase IV multicenter, observational study of 100 pediatric female patients with CPP being treated with SUPPRELIN LA.Sites will extract relevant historical study information from the patients' medical charts and will enter data into an electronic data collection (EDC) system. Additional study information will be collected at the time of routine clinical visits (standard of care)and/or by telephone contact to obtain date of menses. (No study procedures are to be performed only data collection)
We now know that oral ketamine is safe in children with chronic pain, but we do not know which dose (if any) has the potential to control chronic pain in children. This study is a randomized, placebo-controlled, double blinded study that is designed to select the most appropriate dosage of oral ketamine for development as a medicine for control of chronic pain in children. Once this dosage is selected, oral ketamine can be further developed for control of chronic pain in children.
This is a multicenter 48-52 month blinded-outcomes follow up study of subjects who received stannsoporfin or placebo in clinical trial 64,185-204. This clinical trial consists of clinic visits over 4 year period. The developmental tools used in this trial will identify children who are developmentally delayed or at risk for delay.
Extensive blood loss and multiple blood transfusions are a major source of patient complications during and after infant cardiac surgery. The activation of the fibrinolytic system (an enzyme sytem that breaks down blood clots) during surgery is thought to be a main cause of blood clot instability in these patients. Although medications that inhibit this system are routinely used, they also display very variable efficacy and can cause serious side effects. The primary hypothesis of this study is that direct measurement of the activation status of the fibrinolytic system directly inside local tissue (e.g. muscle or wound surfaces) will enable physicians to better evaluate the blood clotting ability of a pediatric heart surgery patient and will substantially improve diagnostic accuracy and drug dosing, thereby reducing the observed side effects such as kidney injury and increased risk of thrombosis.
This study would be the first to examine the application of pediatric constraint induced movement therapy (P-CIMT) in a developing country and could provide important pilot data to expand P-CIMT to larger trials and in other countries. The overarching aim of this proposal is to explore a culturally-relevant and feasible Ethiopian P-CIMT Treatment Model through collaboration with CURE Ethiopia Hospital in Addis Ababa, Ethiopia. If the proposed project demonstrates success at the CURE Ethiopia Hospital, there is immediate potential to educate providers from 28 connected orthopedic clinics within Ethiopia and a network of nine additional CURE Children’s Hospitals in surrounding countries.