The use of low lactose formula (LLF) in term and near-term infants in infants with neonatal abstinence syndrome (NAS) has been increasing recently. However, the clinical evidence of such use is limited. Our aim in this paper was to systematically review the current literature about the use of LLF in infants with NAS. We searched PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Database of Systematic Reviews for articles published between 2015 and 2020. Only randomized controlled trials, prospective, and retrospective studies. The risk of bias was assessed by using published tools appropriate for the study type. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Forty-one titles and/or abstracts were screened independently by 2 reviewers (MA and GA). After an indepth review, 4 studies answered the study question (1 randomized controlled trial (RCT), 2 retrospective studies, and 1 quality improvement study). A meta-analysis could not be completed due to the study type difference and how the outcomes were reported. The studies found no benefit to feeding LLF to infants with NAS regarding short-term outcomes (length of stay, duration, and need for pharmacological therapy and growth). Certainty in the evidence is low. In conclusion we found no beneficial effects regarding the need for pharmacological therapy, duration of pharmacological treatment, length of hospital stay, and growth of using LLF compared to the standard formula in infants with NAS.

ObjectivesThe aim of this scoping review was to identify and review current evidence-based practice (EBP) models and frameworks. Specifically, how EBP models and frameworks used in healthcare settings align with the original model of (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the outcomes of change, along with patient values and preferences and clinical skills.DesignA Scoping review.Included sources and articlesPublished articles were identified through searches within electronic databases (MEDLINE, EMBASE, Scopus) from January 1990 to April 2022. The English language EBP models and frameworks included in the review all included the five main steps of EBP. Excluded were models and frameworks focused on one domain or strategy (eg, frameworks focused on applying findings).ResultsOf the 20 097 articles found by our search, 19 models and frameworks met our inclusion criteria. The results showed a diverse collection of models and frameworks. Many models and frameworks were well developed and widely used, with supporting validation and updates. Some models and frameworks provided many tools and contextual instruction, while others provided only general process instruction. The models and frameworks reviewed demonstrated that the user must possess EBP expertise and knowledge for the step of assessing evidence. The models and frameworks varied greatly in the level of instruction to assess the evidence. Only seven models and frameworks integrated patient values and preferences into their processes.ConclusionMany EBP models and frameworks currently exist that provide diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models and frameworks. Also, the issues of EBP expertise and knowledge to assess evidence must be considered when choosing a model or framework.

Objective: Acute pharyngitis is one of the most common causes of ambulatory clinic visits; however, group A Streptococcus accounts for less than a third. National guidelines recommend against streptococcal testing in patients with viral features. This study aims to assess the rate of inappropriate streptococcal rapid antigen detection tests (RADT)s in children evaluated in urgent care clinics (UCC)s and emergency department (ED)s at a children's hospital. Methods:We retrospectively reviewed charts of 10% of children 3 years or older with RADTs ordered between April and September 2018 at EDs and UCCs. The test was determined to be inappropriate if the patient had no sore throat and/or had 2 or more viral symptoms: rhinorrhea/congestion, cough, diarrhea, hoarseness, conjunctivitis, or viral exanthem.Results: Over the study period, 7678 RADTs were performed, of which 7024 (91.2%) were in children 3 years or older. We evaluated 708 charts and found 44% of RADTs were inappropriate. The predicted probability of inappropriate RADT was highest among patients with a triaged reason for visit for respiratory complaints (70.5%), viral upper respiratory tract infection (69.7%), and rash (61.3%). Of the inappropriate RADTs, 20.1% were positive, whereas 32.2% of the appropriate RADTs were positive. Conclusion:Quality improvement initiatives are needed to decrease the rate of inappropriate RADTs in pediatric UCC and ED settings.

Background Acute pharyngitis is one of the most common causes of pediatric health care visits, accounting for approximately 12 million ambulatory care visits each year. Rapid antigen detection tests (RADTs) for Group A Streptococcus (GAS) are one of the most commonly ordered tests in the ambulatory settings. Approximately 40–60% of RADTs are estimated to be inappropriate. Determination of inappropriate RADT frequently requires time-intensive chart reviews. The purpose of this study was to determine if natural language processing (NLP) can provide an accurate and automated alternative for assessing RADT inappropriateness. Methods Patients ≥ 3 years of age who received an RADT while evaluated in our EDs/UCCs between April 2018 and September 2018 were identified. A manual chart review was completed on a 10% random sample to determine the presence of sore throat or viral symptoms (i.e., conjunctivitis, rhinorrhea, cough, diarrhea, hoarse voice, and viral exanthema). Inappropriate RADT was defined as either absence of sore throat or reporting 2 or more viral symptoms. An NLP algorithm was developed independently to assign the presence/absence of symptoms and RADT inappropriateness. The NLP sensitivity/specificity was calculated using the manual chart review sample as the gold standard. Results Manual chart review was completed on 720 patients, of which 320 (44.4%) were considered to have an inappropriate RADT. When compared to the manual review, the NLP approach showed high sensitivity (se) and specificity (sp) when assigning inappropriateness (88.4% and 90.0%, respectively). Optimal sensitivity/specificity was also observed for select symptoms, including sore throat (se: 92.9%, sp: 92.5%), cough (se: 94.5%, sp: 96.5%), and rhinorrhea (se: 86.1%, sp: 95.3%). The prevalence of clinical symptoms was similar when running NLP on subsequent, independent validation sets. After validating the NLP algorithm, a long term monthly trend report was developed. Figure Inappropriate GAS RADTs Determined by NLP, June 2018-May 2020 Conclusion An NLP algorithm can accurately identify inappropriate RADT when compared to a gold standard. Manual chart review requires dozens of hours to complete. In contrast, NLP requires only a couple of minutes and offers the potential to calculate valid metrics that are easily scaled-up to help monitor comprehensive, long-term trends. Disclosures Brian R. Lee, MPH, PhD, Merck (Grant/Research Support)