Objectives: Children with aerodigestive disorders often have many of the reported risk factors for development of perioperative respiratory adverse events. This study sought to evaluate the incidence of such events in this group of patients undergoing general anesthesia for "triple endoscopy" (flexible bronchoscopy with bronchoalveolar lavage, rigid laryngoscopy and bronchoscopy, and esophagogastroduodenoscopy) and to identify any patient-specific or procedure-specific risk factors associated with higher incidence of perioperative respiratory adverse events. Methods:We performed a retrospective chart review of children 18 years or younger who underwent triple endoscopy as part of an aerodigestive evaluation. Data collected from medical records included: preoperative polysomnography, symptoms of acute respiratory illness, medical comorbidities, demographics, postoperative hospital or intensive care unit admission, and all respiratory events and interventions in the perioperative period. Patient-specific and procedure-specific factors were investigated via univariate analysis for any correlations with perioperative respiratory adverse events. Results:Of the 122 patients undergoing triple endoscopy, 69 (57%) experienced a perioperative respiratory adverse event. We found no difference in the incidence of perioperative respiratory adverse events among children with documented lung disease compared with those with no lung disease (OR: 0.89, p = .8 95% CI: 0.43, 1.8), and no significant difference between those children who had a respiratory illness at the time of surgery, 1-2 weeks prior, 3-4 weeks prior, and those with no preceding respiratory illness. A higher percentage of males had a perioperative respiratory adverse event, compared with females (OR: 2.7, p = .01 95% CI: 1.3, 5.09). Conclusion:Patients undergoing triple endoscopy for evaluation of aerodigestive disorders at our institution experienced perioperative respiratory adverse events at a rate of 57%.

Purpose of review Conventional treatments of atopic dermatitis have been inadequate, especially in patients with moderate-to-severe disease. Recent findings In the past 5 years, four immunomodulators have been approved for the treatment of atopic dermatitis in children. These include dupilumab, ruxolitinib, upadacitinib, and abrocitinib. The review summarizes the pivotal phase 3 trials of these medications. Summary The newer immunomodulators have transformed the treatment of atopic dermatitis, particularly in patients with moderate-to-severe disease. Dupilumab targets IL-4 and IL-13, which are the main causes of allergic inflammation, resulting in great efficacy and few side effects. Upadacitinib and abrocitinib are alternative systemic medications for adolescents who have failed or are unable to tolerate dupilumab. Ruxolitinib cream is the latest addition to the current topical therapy. It is indicated for children 12 years and older with mild-to-moderate atopic dermatitis. Further studies are needed to confirm its safety and efficacy for younger children and for patients with more severe disease.

Introduction:The electronic health record (EHR) has increased time spent outside of face-to-face encounters, with higher EHR burden associated with differences in provider sex, specialty, and rates of burnout. However, the EHR burden specific to gastroenterology (GI) providers is not fully understood. Methods: Measures of EHR use calculated through Epic Systems were retrospectively collected for GI providers from a tertiary referral center during a 6-month period starting January 1, 2021. Primary measures used to characterize EHR use included time spent performing clinical review, documentation, and in-basket management as well as quantification of efficiency, messaging, and time logged into the EHR, including time outside regularly scheduled hours (5:30 p.m. to 7:00 a.m. and weekends). EHR use patterns were compared across provider sex, sub-specialty (inflammatory bowel disease [IBD], motility/irritable bowel syndrome, advanced endoscopy [AE], and esophagus [ESO]), and training (physician vs non-physician provider [NPP]). Data was analyzed in aggregate using t-tests and analysis of variance with post-hoc Boniferri correction. Results: Data from 33 providers compromising 3,743 clinic days and 16,572 appointments was collected. Overall, 69.7% (23/33) were physicians, 30.3% (10/33) NPPs and 48.5% (16/33) were women, with women comprising all NPPs. Comparing EHR burden across sexes, women spent more daily time in clinical review than men (42.4 minutes vs 26.0, P 5 0.02), though this result lost statistical significance when excluding NPPs. Comparing sub-specialties, IBD specialists spent more daily time in clinical review per appointment than AEs or ESOs (13.7 minutes vs 3.9 and 3.7, respectively; P , 0.001) yet had higher efficiency scores compared to these sub-specialties (P , 0.001). Compared to AEs, IBD specialists spent more overall daily time in the EHR (131.5 minutes vs 39.7, P , 0.005) as well as more daily time outside of regular work hours (60.0 minutes vs 8.9, P , 0.01). Comparing provider training, NPPs spent more daily time in the in-basket (P 5 0.03), clinical review (P 5 0.02), and overall EHR (P , 0.001) than physicians. Additionally, NPPs received more patient medical advice request messages per day than physicians (P 5 0.03). Conclusion: IBD specialists and NPPs have an increased EHR burden. More work is needed to better understand sex, sub-specialty, and training-based differences in workload to combat factors contributing to provider burnout.