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https://www.readbyqxmd.com/read/28444652/-establishment-of-specialized-pediatric-palliative-home-care-in-the-medical-valley-of-the-european-metropolitan-area-nuremberg
#1
Steven Hébert, Chara Gravou-Apostolatou, Wolfgang Rascher
Background As part of the 2007 health reform in Germany the structure of outpatient palliative care for children and adolescents was adopted for the first time and then implemented in Erlangen-Nuremberg in 2009. Methods The introduction of Pediatric Palliative Home Care (PPHC) at the Hospital for Children and Adolescents at the University of Erlangen-Nuremberg was retrospectively analyzed between the years 2009 to 2014. Referring medical records (paper-based and electronic) were evaluated systematically. Results Considering 69 patients within this study, 44 (63...
March 2017: Klinische Pädiatrie
https://www.readbyqxmd.com/read/28444383/optimizing-drug-dose-alerts-using-commercial-software-throughout-an-integrated-health-care-system
#2
Salim M Saiyed, Peter J Greco, Glenn Fernandes, David C Kaelber
All default electronic health record and drug reference database vendor drug-dose alerting recommendations (single dose, daily dose, dose frequency, and dose duration) were silently turned on in inpatient, outpatient, and emergency department areas for pediatric-only and nonpediatric-only populations. Drug-dose alerts were evaluated during a 3-month period. Drug-dose alerts fired on 12% of orders (104 098/834 911). System-level and drug-specific strategies to decrease drug-dose alerts were analyzed. System-level strategies included: (1) turning off all minimum drug-dosing alerts, (2) turning off all incomplete information drug-dosing alerts, (3) increasing the maximum single-dose drug-dose alert threshold to 125%, (4) increasing the daily dose maximum drug-dose alert threshold to 125%, and (5) increasing the dose frequency drug-dose alert threshold to more than 2 doses per day above initial threshold...
April 24, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28435306/pediatric-acute-kidney-injury-prevalence-impact-and-management-challenges
#3
REVIEW
Eileen Ciccia, Prasad Devarajan
The incidence of pediatric acute kidney injury (AKI) is increasing globally, as are the associated morbidities and mortality. A recent standardization of the definition of AKI has allowed for a more accurate assessment of the epidemiology of pediatric AKI. Recent advances in leveraging electronic medical health record systems have allowed for real-time risk stratification and prevention of pediatric AKI in the hospital setting. Newly developed and validated clinical scores have improved our ability to predict AKI and provide a rational context for biomarker utilization in hospitalized children...
2017: International Journal of Nephrology and Renovascular Disease
https://www.readbyqxmd.com/read/28434027/can-ultrasound-be-used-as-the-primary-imaging-in-children-with-suspected-crohn-disease
#4
Timothy L Tsai, Megan B Marine, Matthew R Wanner, Matthew L Cooper, Steven J Steiner, Fangqian Ouyang, S Gregory Jennings, Boaz Karmazyn
BACKGROUND: There is growing literature on the use of ultrasound (US) for evaluation of Crohn disease in adults, but few studies have been conducted on children. Several studies demonstrated high accuracy of US in the diagnosis of Crohn disease. Using US as the primary screening imaging modality for Crohn disease can reduce health care costs, the need for sedation and ionizing radiation exposure. OBJECTIVE: The aim of our study is to determine if US can be used for screening evaluation of pediatric Crohn disease...
April 22, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28418800/predictors-of-breastfeeding-initiation-and-maintenance-in-an-integrated-healthcare-setting
#5
Michelle L Henninger, Stephanie A Irving, Tia L Kauffman, Samantha K Kurosky, Kathryn Rompala, Mark G Thompson, Leslie Z Sokolow, Lyndsay Ammon Avalos, Sarah W Ball, Pat Shifflett, Allison L Naleway
BACKGROUND: The American Academy of Pediatrics recommends exclusive breastfeeding to age 6 months. Although breastfeeding rates in the United States have been increasing over time, further improvements are needed to meet Healthy People 2020 targets. Research aim: This study examined predictors of breastfeeding initiation and maintenance among a population of insured pregnant women. METHODS: Participants were 1,149 pregnant women enrolled in the Pregnancy and Influenza Project in two Kaiser Permanente regions in 2010-2011...
May 2017: Journal of Human Lactation: Official Journal of International Lactation Consultant Association
https://www.readbyqxmd.com/read/28415965/the-pregnancy-environment-and-lifestyle-study-petals-a-population-based-longitudinal-multi-racial-birth-cohort
#6
Yeyi Zhu, Monique M Hedderson, Juanran Feng, Ashley A Mevi, Assiamira Ferrara
BACKGROUND: Increasing recognition has been received regarding the proven and suggested links between multi-level environmental exposures on a broad scale (e.g., chemical, clinical, behavioral, physical and social) and health deficits originated from the critical window of development. However, such prospective human data are limited. In 2016, the National Institutes of Health funded 35 centers comprising 84 extant cohorts for the Environmental Influences on Child Health Outcomes (ECHO) pediatric cohorts program...
April 17, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28412573/patient-characteristics-associated-with-differences-in-radiation-exposure-from-pediatric-abdomen-pelvis-ct-scans-a-quantile-regression-analysis
#7
Jennifer N Cooper, Daniel L Lodwick, Brent Adler, Choonsik Lee, Peter C Minneci, Katherine J Deans
BACKGROUND: Computed tomography (CT) is a widely used diagnostic tool in pediatric medicine. However, due to concerns regarding radiation exposure, it is essential to identify patient characteristics associated with higher radiation burden from CT imaging, in order to more effectively target efforts towards dose reduction. Our objective was to identify the effects of various demographic and clinical patient characteristics on radiation exposure from single abdomen/pelvis CT scans in children...
April 12, 2017: Computers in Biology and Medicine
https://www.readbyqxmd.com/read/28410277/use-of-population-pharmacokinetics-and-electronic-health-records-to-assess-piperacillin-tazobactam-safety-in-infants
#8
Sara Salerno, Christoph P Hornik, Michael Cohen-Wolkowiez, P Brian Smith, Lawrence C Ku, Matthew S Kelly, Reese Clark, Daniel Gonzalez
BACKGROUND: Piperacillin, in combination with tazobactam, is frequently used in infants for treating nosocomial infections, although safety data in this population are limited. Electronic health record (EHR) data can be used to evaluate drug safety in infants, but measures of drug exposure are lacking. METHODS: To relate simulated piperacillin exposure with adverse events (AEs) in infants using EHR data, we identified infants discharged from 333 neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2012...
April 13, 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28398525/a-longitudinal-analysis-of-data-quality-in-a-large-pediatric-data-research-network
#9
Ritu Khare, Levon Utidjian, Byron J Ruth, Michael G Kahn, Evanette Burrows, Keith Marsolo, Nandan Patibandla, Hanieh Razzaghi, Ryan Colvin, Daksha Ranade, Melody Kitzmiller, Daniel Eckrich, L Charles Bailey
Objective: PEDSnet is a clinical data research network (CDRN) that aggregates electronic health record data from multiple children's hospitals to enable large-scale research. Assessing data quality to ensure suitability for conducting research is a key requirement in PEDSnet. This study presents a range of data quality issues identified over a period of 18 months and interprets them to evaluate the research capacity of PEDSnet. Materials and Methods: Results were generated by a semiautomated data quality assessment workflow...
April 8, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28382879/frequent-users-of-the-pediatric-emergency-department
#10
Jade Seguin, Esli Osmanlliu, Xun Zhang, Virginie Clavel, Harley Eisman, Robert Rodrigues, Maryam Oskoui
OBJECTIVES: Emergency department (ED) crowding is associated with increased morbidity and mortality. Its etiology is multifactorial, and frequent ED use (defined as more or equal to five visits per year) is a major contributor to high patient volumes. Our primary objective is to characterize the frequent user population. Our secondary objective is to examine risk factors for frequent emergency use. METHODS: We conducted a retrospective cohort study of pediatric emergency department (PED) visits at the Montreal Children's Hospital using the Système Informatique Urgence (SIURGE), electronic medical record database...
April 6, 2017: CJEM
https://www.readbyqxmd.com/read/28339689/genomic-decision-support-needs-in-pediatric-primary-care
#11
Jeffrey W Pennington, Dean J Karavite, Edward M Krause, Jeffrey Miller, Barbara A Bernhardt, Robert W Grundmeier
Clinical genome and exome sequencing can diagnose pediatric patients with complex conditions that often require follow-up care with multiple specialties. The American Academy of Pediatrics emphasizes the role of the medical home and the primary care pediatrician in coordinating care for patients who need multidisciplinary support. In addition, the electronic health record (EHR) with embedded clinical decision support is recognized as an important component in providing care in this setting. We interviewed 6 clinicians to assess their experience caring for patients with complex and rare genetic findings and hear their opinions about how the EHR currently supports this role...
February 19, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28334588/applying-the-chronic-care-model-to-improve-care-and-outcomes-at-a-pediatric-medical-center
#12
Jennifer Lail, Pamela J Schoettker, Denise L White, Bhavna Mehta, Uma R Kotagal
BACKGROUND: Cincinnati Children's Hospital Medical Center launched the Condition Outcomes Improvement Initiative in 2012 to help disease-based teams use the principles of improvement science to implement components of the Chronic Care Model and improve outpatient care delivery for populations of children with chronic and complex conditions. The goal was to improve outcomes by 20% from baseline. METHODS: Initiative activities included review of the evidence to choose and measure outcomes, development of condition-specific patient registries and tools for data collection, patient stratification, planning and coordinating care before and after visits, and self-management support...
March 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28334566/improving-communication-with-primary-care-physicians-at-the-time-of-hospital-discharge
#13
Lauren A Destino, Amy Dixit, Julie L Pantaleoni, Matthew S Wood, Natalie M Pageler, Joe Kim, Terry S Platchek
BACKGROUND: Communication with primary care physicians (PCPs) at the time of a patient's hospital discharge is important to safely transition care to home. The goal of this quality improvement initiative was to increase discharge communication to PCPs at an academic children's hospital. METHODS: A multidisciplinary team at Lucile Packard Children's Hospital Stanford used Lean A3 problem solving methodology to address the problem of inadequate discharge communication with PCPs...
February 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28333698/misuse-of-pediatric-medications-and-parent-physician-communication-an-interactive-voice-response-intervention
#14
Kathleen E Walsh, Janine Bacic, Barrett D Phillips, William G Adams
BACKGROUND: Children take 1 medication each week on average at home. Better communication between parents and providers could support safer home medication use and prevent misuse of pediatric medications, such as intentional underdosing or overdosing. Our primary objective was to assess the impact of an interactive voice response system on parent-provider communication about medications. METHODS: Parents of children 4 months to 11 years of age with upcoming well child visits were invited to call our interactive voice response system, called Personal Health Partner (PHP), which asked questions about the child's health and medication use...
March 22, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/28332939/pediatric-asthma-hospitalizations-among-urban-minority-children-and-the-continuity-of-primary-care
#15
Levon H Utidjian, Alexander G Fiks, A Russell Localio, Lihai Song, Mark J Ramos, Ron Keren, Louis M Bell, Robert W Grundmeier
OBJECTIVE: To examine the effect of ambulatory health care processes on asthma hospitalizations. METHODS: A retrospective cohort study using electronic health records was completed. Patients aged 2-18 years receiving health care from 1 of 5 urban practices between Jan 1, 2004 and Dec 31, 2008 with asthma documented on their problem list were included. Independent variables were modifiable health care processes in the primary care setting: (1) use of asthma controller medications; (2) regular assessment of asthma symptoms; (3) use of spirometry; (4) provision of individualized asthma care plans; (5) timely influenza vaccination; (6) access to primary healthcare; and (7) use of pay for performance physician incentives...
February 25, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/28324321/structured-data-entry-in-the-electronic-medical-record-perspectives-of-pediatric-specialty-physicians-and-surgeons
#16
Ruth A Bush, Cynthia Kuelbs, Julie Ryu, Wen Jiang, George Chiang
The Epic electronic health record (EHR) platform supports structured data entry systems (SDES), which allow developers, with input from users, to create highly customized patient-record templates in order to maximize data completeness and to standardize structure. There are many potential advantages of using discrete data fields in the EHR to capture data for secondary analysis and epidemiological research, but direct data acquisition from clinicians remains one of the largest obstacles to leveraging the EHR for secondary use...
May 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28293684/meaningful-use-of-an-electronic-personal-health-record-ephr-among-pediatric-cancer-survivors
#17
Rebecca S Williamson, Brooke O Cherven, Jordan Gilleland Marchak, Paula Edwards, Michael Palgon, Cam Escoffery, Lillian R Meacham, Ann C Mertens
Background and Objectivs: Survivors of pediatric and adolescent cancer are at an increased risk of chronic and debilitating health conditions and require life-long specialized care. Stand-alone electronic personal health records (ePHRs) may aid their self-management. This analysis characterizes young adult survivors and parents who meaningfully use an ePHR, Cancer SurvivorLink(TM), designed for survivors of pediatric and adolescent cancer. METHODS: This was a retrospective observational study of patients seen at a pediatric survivor clinic for annual survivor care...
March 15, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28291152/medical-student-documentation-in-the-emergency-department-in-the-electronic-health-record-era-a-national-survey
#18
Ryan A Virden, F Meridith Sonnett, Abu N G A Khan
OBJECTIVES: Implementation of electronic health record (EHR) has generated a new challenge in the practice of medical student documentation in the emergency department (ED). This study discerns both the current practices and consensus opinions of pediatric ED directors and Association of American Medical Colleges (AAMC) student representatives regarding best practices for documentation by medical students in the ED EHR nationwide. METHODS: The authors conducted a cross-sectional Web-based survey of the directors of academic pediatric EDs and AAMC student representatives using Qualtric survey engine...
March 13, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28291130/making-the-pediatric-perioperative-surgical-home-come-to-life-by-leveraging-existing-health-information-technology
#19
Izabela C Leahy, Rachel Borczuk, Lynne R Ferrari
PURPOSE OF REVIEW: To design a patient data dashboard for the Department of Anesthesiology, Perioperative and Pain Medicine at Boston Children's Hospital that supports care integration across the healthcare system as described by the pediatric perioperative surgical home (PPSH) initiative. RECENT FINDINGS: By using 360 Technology, patient data was automatically pulled from all available Electronic Health Record sources from 2005 to the present. The PPSH dashboard described in this report provides a guide for implementation of PPSH Clinical Care Pathways...
March 11, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28277414/implementation-of-an-electronic-clinical-decision-support-tool-for-pediatric-appendicitis-within-a-hospital-network
#20
Marissa A Hendrickson, Andrew R Wey, Philippe R Gaillard, Anupam B Kharbanda
OBJECTIVES: Computed tomography (CT) has been widely used in the evaluation of children with suspected appendicitis, but concerns about ionizing radiation have increased interest in ultrasound for these patients. We sought to assess the effectiveness of an appendicitis electronic clinical decision support (E-CDS) system in increasing ultrasound and decreasing CT use in children evaluated in emergency departments (EDs) for suspected appendicitis. METHODS: This was a preintervention and postintervention analysis of an E-CDS implemented into an electronic health record system shared by an academic, tertiary-care children's hospital and a community hospital...
March 9, 2017: Pediatric Emergency Care
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