Evidence map›Paper›PMID 24629404›Full record

ArticleAcademic pediatrics

Asthma treatment decisions by pediatric residents do not consistently conform to guidelines or improve with level of training.

Sande O Okelo, George K Siberry, Barry S Solomon, Andrew L Bilderback, Michiyo Yamazaki, Theresa Hetzler, Cynthia L Ferrell, Nui Dhepyasuwan, Janet R Serwint, CORNET Investigators

2 registry-linked trialsOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Academic pediatrics. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.5field-weighted citation impact, top 32% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03066596 nacompletednot on this map

Promoting Asthma Guidelines and Management Through Technology-Based Intervention and Care Coordination

TypeinterventionalSponsorMontefiore Medical CenterRan2017 to 2024Enrolled530ConditionsAsthma ChildhoodArmseMPI
NCT07224061 narecruitingnot on this map

Promoting Asthma Guidelines and Management Through Technology-Based Intervention and Care Coordination in Clinics and Schools (PRAGMATIC-S)

TypeinterventionalSponsorMontefiore Medical CenterRan2026 to 2033Enrolled420ConditionsAsthma in ChildrenArmsPRAGMATIC-S
3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 5 citations in OpenAlex.

  1. Improving asthma care in a pediatric resident clinic.BMJ quality improvement reports · 2016
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 7 institutions in 1 country.

Sande O OkeloDivision of Pediatric Pulmonology, The David Geffen School of Medicine at UCLA, Los Angeles, Calif. Electronic address: sokelo@mednet.ucla.edu.
George K SiberryPediatric, Adolescent, and Maternal AIDS (PAMA) Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md.
Barry S SolomonDivision of General Pediatrics & Adolescent Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md.
Andrew L BilderbackDepartment of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md.
Michiyo YamazakiDepartment of Family, Population and Reproductive Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
Theresa HetzlerDepartment of Pediatrics, New York Medical College, Valhalla, NY.
Cynthia L FerrellDepartment of Pediatrics, Oregon Health & Science University, Portland, Ore.
Nui DhepyasuwanAcademic Pediatric Association, McLean, Va.
Janet R SerwintDivision of General Pediatrics & Adolescent Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md.
CORNET Investigators
Johns Hopkins Medicine · USJohns Hopkins University · USAcademic Pediatric Association · USEunice Kennedy Shriver National Institute of Child Health and Human Development · USNew York Medical College · USOregon Health & Science University · USUniversity of California, Los Angeles · US

Funding

Development of a Pediatric Asthma Control and Communication InstrumentK23HL089410 · NHLBI · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI OKELO, SANDE O · 2008 to 2012
$715k
NHLBI NIH HHS K23 HL089410NHLBI NIH HHS K23HL089410
6 · The paper itself

Abstract

objectiveTo compare asthma treatment decisions by pediatric residents to current asthma guidelines and to learn whether treatment decisions vary by postgraduate year in training.

methodsWe conducted a Web-based survey of residents from 10 training programs through the Continuity Research Network of the Academic Pediatric Association (CORNET). Surveys included 6 vignettes of patients receiving low-dose inhaled steroids with guideline- and non-guideline-based indicators of asthma status and 1 stable patient on high-intensity medication.

resultsThere were 369 resident respondents (65% response rate), 26% postgraduate year (PGY) 1, 38% PGY2, and 36% PGY3+. Seventy-five percent of each resident group reported seeing fewer than 1 asthma patient per continuity clinic session. A majority of residents made appropriate treatment recommendations in 2 of 4 vignettes of guideline-based indicators of asthma status: first, 97% overall stepping up treatment for mild persistent asthma; and second, 52% overall stepping down treatment for a patient with well-controlled asthma on high-intensity medications. Inconsistent with guideline recommendations, 82% of residents overall did not step down treatment for a patient with well-controlled asthma receiving low-intensity therapy; 75% of residents did not step up treatment for a patient with a recent hospitalization for asthma. Of the 3 vignettes evaluating non-guideline-based indicators of asthma status, a majority of residents (60%) stepped up treatment for parental reports of worse asthma, while a minority did so for a parental report of being bothered by their child's asthma (27%) or when wheezing was reported at physical examination (43%). There were no statistically significant differences for any of the comparisons by year in training.

conclusionsPediatric residents' management of asthma is consistent with national guidelines in some cases but not in others. There were no differences in the outpatient asthma management decisions between residents by years in training. Educational efforts should be focused on strategies to facilitate pediatric resident adherence to national asthma guideline recommendations for outpatient asthma management.

Indexed as

Practice Guidelines as TopicAdultAnti-Asthmatic AgentsAsthmaChildChild, PreschoolClinical CompetenceDecision MakingDisease ManagementFemaleGuideline AdherenceHumansInternship and ResidencyMalePediatricsAnti-Asthmatic AgentsasthmaCORNETdecision makingpediatric resident educationsurveytreatmentvignettes

Identifiers

PMID24629404
PMCPMC8923062
OpenAlexW2138493120

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.