Evidence map›Paper›PMID 42318643›Full record

ArticleClinical and translational science2026

When Science Outpaces Infrastructure: People, Process, and Technology Challenges for Precision Dosing in Children.

Tamorah Lewis, Karim Jessa, Vijay Ivaturi, Andreas Noack, Dilum P Aluthge, David Müller-Widmann, Kathryn Capello, Matthew Fong, Ashleigh Miatello, Melanie Barwick

Abstract read
In one paragraph

Article in Clinical and translational science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

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.

Tamorah LewisDivision of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada.ORCID 0000-0003-2137-8339
Karim JessaDepartment of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada.ORCID 0009-0001-7582-8422
Vijay IvaturiPumas-AI, Inc, Dover, Delaware, USA.ORCID 0000-0002-6433-1154
Andreas NoackPumas-AI, Inc, Dover, Delaware, USA.
Dilum P AluthgePumas-AI, Inc, Dover, Delaware, USA.ORCID 0000-0002-9247-0530
David Müller-WidmannPumas-AI, Inc, Dover, Delaware, USA.ORCID 0000-0001-9282-053X
Kathryn CapelloThe Hospital for Sick Children, Information Management & Technology, Project Management Office, Toronto, Ontario, Canada.
Matthew FongEpic Application Special Team, Department of Information Services, The Hospital for Sick Children, Toronto, Ontario, Canada.
Ashleigh MiatelloChild Health Evaluative Services, the Hospital for Sick Children, Toronto, Ontario, Canada.ORCID 0000-0002-1711-8676
Melanie BarwickChild Health Evaluative Services, the Hospital for Sick Children, Toronto, Ontario, Canada.ORCID 0000-0002-2478-604X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The implementation of novel precision medicine tools in pediatric medicine requires buy-in from multiple interest groups and a shift from traditional medical paradigms. In an effort to implement a precision drug-dosing project for an anti-coagulant drug in the neonatal intensive care unit (NICU) at a large children's hospital, a multi-specialty team made up of clinicians, scientists, private industry, and technology specialists formed and worked collaboratively over multiple years. Despite best efforts, the project's success was hindered by multiple foreseen and unforeseen barriers. Through the telling of a specific case example, these barriers and the key considerations for mitigating them are discussed to give future teams better knowledge and preparation abilities. The themes discussed are encompassed by "people," "process," and "technology." The integration of precision dosing tools into hospital systems (such as electronic health records [EHR]) demands careful coordination across clinicians, pharmacists, nurses, and hospital information technology (IT) teams. Informaticians play a key role in safely embedding innovations into clinical practice. Ethics boards face challenges evaluating novel technologies like AI/ML. Comprehensive representation on ethics boards is essential for effective oversight of new digital tools. Technical integration of third-party applications into EHRs is complex, especially across international borders. Differences in measurement units, coding systems, and test environments can cause deployment issues. Privacy assessments, secure data access protocols, and data residency and compliance are critical. Finally, sustaining precision medicine innovations requires institutional investment beyond initial research funding. Success hinges on attention to people, process, and technology.

Indexed as

AnticoagulantsPediatricsPrecision MedicineChildElectronic Health RecordsHospitals, PediatricHumansInfant, NewbornIntensive Care Units, NeonatalAnticoagulantsimplementationMIPDpharmacology

Identifiers

PMID42318643
PMCPMC13280557

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

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.