BackgroundDespite their potential benefits, many electronic health (eHealth) innovations evaluated in major studies fail to integrate into organizational routines, and the implementation of these innovations remains problematic.ObjectiveThe purpose of this study was to describe health care professionals’ self-identified perceived barriers and facilitators for the implementation of a Web-based portal to monitor asthmatic children as a substitution for routine outpatient care. Also, we assessed patients’ (or their parents) satisfaction with this eHealth innovation.MethodsBetween April and November 2015, we recruited 76 health care professionals (from 14 hospitals). During a period of 6 months, participants received 3 questionnaires to identify factors that facilitated or impeded the use of this eHealth innovation. Questionnaires for patients (or parents) were completed after the 6-month virtual asthma clinic (VAC) implementation period.ResultsMajor perceived barriers included concerns about the lack of structural financial reimbursement for Web-based monitoring, lack of integration of this eHealth innovation with electronic medical records, the burden of Web-based portal use on clinician workload, and altered patient-professional relationship (due to fewer face-to-face contacts). Major perceived facilitators included enthusiastic and active initiators, a positive attitude of professionals toward eHealth, the possibility to tailor care to individual patients (“personalized eHealth”), easily deliverable care according to current guidelines using the VAC, and long-term profit and efficiency.ConclusionsThe implementation of Web-based disease monitoring and management in children is complex and dynamic and is influenced by multiple factors at the levels of the innovation itself, individual professionals, patients, social context, organizational context, and economic and political context. Understanding and defining the barriers and facilitators that influence the context is crucial for the successful implementation and sustainability of eHealth innovations.

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Objective: We aimed to describe a case of prematurely born infant with accidental sildenafil overdose.Methods: This was a retrospective case report followed with chart and literature review.Main Findings: A prematurely born infant with moderate bronchopulmonary dysplasia, corrected congenital heart disease, and pulmonary hypertension presented with an accidental sildenafil overdose. Despite the relatively high dose in this medically frail infant and the long elimination half-life of sildenafil in infants, the symptoms of sildenafil overdose in our patient were only mild. After a short and uneventful period of observation in the hospital, the patient was discharged home.Conclusions: Sildenafil overdose can cause serious symptoms such as hypotension. However, in our case, the sildenafil overdose was well tolerated, even by a young patient with underlying heart and lung disease. We show that choices in the management of sildenafil intoxication can be made based on the knowledge of sildenafil pharmacokinetics in young children.

Inappropriate pharmacotherapy is common and is an important cause of harm to patients. The incidence of preventable adverse drug events is high worldwide, with rates ranging from 16.5 to 52.9%. [1][2][3] It is also estimated that 70% of preventable adverse drug events are due to inappropriate prescribing. 4,5 Junior doctors working in secondary care, who write out most prescriptions in hospital, prescribe incorrectly in 8-10% of cases, sometimes with fatal consequences. 6,7 One reason for these errors is that junior doctors tend to base their drug choices on examples learned from their medical teachers instead of on their own autonomous therapeutic reasoning. 8 Moreover, junior doctors themselves do not feel well prepared to prescribe after graduation,

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