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https://www.readbyqxmd.com/read/28521558/rising-utilization-of-inpatient-pediatric-asthma-pathways
#1
Sunitha V Kaiser, Jonathan Rodean, Arpi Bekmezian, Matt Hall, Samir S Shah, Sanjay Mahant, Kavita Parikh, Rustin Morse, Henry Puls, Michael D Cabana
INTRODUCTION: Clinical pathways are detailed care plans that operationalize evidence-based guidelines into an accessible format for health providers. Their goal is to link evidence to practice to optimize patient outcomes and delivery efficiency. It is unknown to what extent inpatient pediatric asthma pathways are being utilized nationally. OBJECTIVES: (1) Describe inpatient pediatric asthma pathway design and implementation across a large hospital network. (2) Compare characteristics of hospitals with and without pathways...
May 19, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/28514310/development-and-validation-of-a-mortality-risk-model-for-pediatric-sepsis
#2
Mengshi Chen, Xiulan Lu, Li Hu, Pingping Liu, Wenjiao Zhao, Haipeng Yan, Liang Tang, Yimin Zhu, Zhenghui Xiao, Lizhang Chen, Hongzhuan Tan
Pediatric sepsis is a burdensome public health problem. Assessing the mortality risk of pediatric sepsis patients, offering effective treatment guidance, and improving prognosis to reduce mortality rates, are crucial.We extracted data derived from electronic medical records of pediatric sepsis patients that were collected during the first 24 hours after admission to the pediatric intensive care unit (PICU) of the Hunan Children's hospital from January 2012 to June 2014. A total of 788 children were randomly divided into a training (592, 75%) and validation group (196, 25%)...
May 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28511684/access-to-pediatric-rheumatology-care-for-juvenile-idiopathic-arthritis-in-the-united-arab-emirates
#3
Khulood Khawaja, Mustafa Al-Maini
BACKGROUND: This study looks at access to care for Juvenile Idiopathic Arthritis through pediatric rheumatology in the UAE, as an example of multi-ethnic society. METHODS: Patients with a diagnosis of Juvenile idiopathic arthritis were identified through the hospital electronic medical records system from January 1st 2011 to December 31st 2014. All residents of the United Arab Emirates hold an Emirates identity card. We divided our patients into two groups: Emirati-Emirates, who are native Emirati children and hold the Emirati nationality, as stated on their Emirates identity card, and who therefore have full, comprehensive access to free medical care; and non-Emirati-Emirates, who represent other nationalities, as stated on their Emirates identity card...
May 16, 2017: Pediatric Rheumatology Online Journal
https://www.readbyqxmd.com/read/28493451/the-effect-of-an-electronic-health-record-based-tool-on-abnormal-pediatric-blood-pressure-recognition
#4
Sarah A Twichell, Corinna J Rea, Patrice Melvin, Andrew J Capraro, Joshua C Mandel, Michael A Ferguson, Daniel J Nigrin, Kenneth D Mandl, Dionne Graham, Justin P Zachariah
BACKGROUND: Recognition of high blood pressure (BP) in children is poor, partly due to the need to compute age-sex-height referenced percentiles. This study examined the change in abnormal BP recognition before versus after the introduction of an electronic health record (EHR) app designed to calculate BP percentiles with a training lecture. METHODS AND RESULTS: Clinical data were extracted on all ambulatory, non-urgent encounters for children 3-18 years old seen in primary care, endocrinology, cardiology, or nephrology clinics at an urban, academic hospital in the year before and the year after app introduction...
May 11, 2017: Congenital Heart Disease
https://www.readbyqxmd.com/read/28489227/using-quality-improvement-in-resident-education-to-improve-transition-care
#5
Sofija D Volertas, Rita Rossi-Foulkes
The importance of a specific transition process is recognized by many health organizations. Got Transition, a cooperative endeavor aimed at improving the transition from pediatric to adult health care, developed Six Core Elements defining the basic components of health care transition support. In this article, we review the Six Core Elements by presenting a model that combines resident quality improvement and transition care training. In this Internal Medicine-Pediatrics residency program, ambulatory training for residents takes place in a combined adult and pediatric clinic...
May 1, 2017: Pediatric Annals
https://www.readbyqxmd.com/read/28487930/the-effects-of-medication-alerts-on-prescriber-response-in-a-pediatric-hospital
#6
Judith W Dexheimer, Eric S Kirkendall, Michal Kouril, Philip A Hagedorn, Thomas Minich, Leo L Duan, Monifa Mahdi, Rhonda Szczesniak, S Andrew Spooner
OBJECTIVE: More than 70% of hospitals in the United States have electronic health records (EHRs). Clinical decision support (CDS) presents clinicians with electronic alerts during the course of patient care; however, alert fatigue can influence a provider's response to any EHR alert. The primary goal was to evaluate the effects of alert burden on user response to the alerts. METHODS: We performed a retrospective study of medication alerts over a 24-month period (1/2013-12/2014) in a large pediatric academic medical center...
May 10, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28486440/electronic-health-record-based-predictive-models-for-acute-kidney-injury-screening-in-pediatric-inpatients
#7
Li Wang, Tracy L McGregor, Deborah P Jones, Brian C Bridges, Geoffrey M Fleming, Jana Shirey-Rice, Michael F McLemore, Lixin Chen, Asli Weitkamp, Daniel W Byrne, Sara L Van Driest
BACKGROUNDAcute kidney injury (AKI) is common in pediatric inpatients and associated with increased morbidity, mortality, and length of stay. Early identification can reduce severity.METHODSTo create and validate an electronic health record (EHR)-based AKI screening tool, we generated temporally distinct development and validation cohorts using retrospective data from our tertiary care children's hospital, including children 28 days through 21 years old with sufficient serum creatinine measurements to determine AKI status...
May 9, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28477050/revealing-the-prevalence-and-consequences-of-food-insecurity-in-children-with-epilepsy
#8
Jennifer A O'Malley, Bethany M Klett, Melissa D Klein, Nicole Inman, Andrew F Beck
Food insecurity (FI) affects more than one in five American children and is increasingly addressed during pediatric primary care. Its relevance during subspecialty care, including in the treatment of chronic conditions like epilepsy, is largely unknown. This study sought to determine the FI prevalence among children with epilepsy and examine the relationship between FI and healthcare utilization, health-related quality-of-life (HR-QOL), and medication side effect control. This was a retrospective cohort study using electronic health record data from children, aged 2-17 years, seen for epilepsy management at an academic pediatric hospital...
May 5, 2017: Journal of Community Health
https://www.readbyqxmd.com/read/28476461/adding-social-determinant-data-changes-children-s-hospitals-readmissions-performance
#9
Marion R Sills, Matthew Hall, Gretchen J Cutler, Jeffrey D Colvin, Laura M Gottlieb, Michelle L Macy, Jessica L Bettenhausen, Rustin B Morse, Evan S Fieldston, Jean L Raphael, Katherine A Auger, Samir S Shah
OBJECTIVES: To determine whether social determinants of health (SDH) risk adjustment changes hospital-level performance on the 30-day Pediatric All-Condition Readmission (PACR) measure and improves fit and accuracy of discharge-level models. STUDY DESIGN: We performed a retrospective cohort study of all hospital discharges meeting criteria for the PACR from 47 hospitals in the Pediatric Health Information database from January to December 2014. We built four nested regression models by sequentially adding risk adjustment factors as follows: chronic condition indicators (CCIs); PACR patient factors (age and sex); electronic health record-derived SDH (race, ethnicity, payer), and zip code-linked SDH (families below poverty level, vacant housing units, adults without a high school diploma, single-parent households, median household income, unemployment rate)...
May 2, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28467377/natural-history-of-nafld-diagnosed-in-childhood-a-single-center-study
#10
Catherine E Cioffi, Jean A Welsh, Rebecca L Cleeton, Shelley A Caltharp, Rene Romero, Mark L Wulkan, Juna V Konomi, Jennifer K Frediani, Miriam B Vos
Little is known regarding the subsequent course of non-alcoholic fatty liver disease (NAFLD) diagnosed in childhood. The objectives of this single-center study were to gather data on long-term health outcomes and to assess the feasibility of contacting former pediatric patients. In a large pediatric medical center, electronic records were searched to initially identify 162 former patients who had a liver biopsy between 2000 and 2010. Of these, 44 subjects met the criteria for age at follow-up (≥18 year) and biopsy-proven NAFLD, and were recruited via postal and electronic mail...
May 3, 2017: Children
https://www.readbyqxmd.com/read/28455273/exploring-workarounds-related-to-electronic-health-record-system-usage-a-study-protocol
#11
Vincent Blijleven, Kitty Koelemeijer, Monique Jaspers
BACKGROUND: Health care providers resort to informal temporary practices known as workarounds for handling exceptions to normal workflow that are unintentionally imposed by electronic health record (EHR) systems. Although workarounds may seem favorable at first sight, they are generally suboptimal and may jeopardize patient safety, effectiveness, and efficiency of care. Identifying workarounds and understanding their motivations, scope, and impact is pivotal to support the design of user-friendly EHRs and achieve closer alignment between EHRs and work contexts...
April 28, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28453637/automated-identification-of-implausible-values-in-growth-data-from-pediatric-electronic-health-records
#12
Carrie Daymont, Michelle E Ross, A Russell Localio, Alexander G Fiks, Richard C Wasserman, Robert W Grundmeier
Objective: Large electronic health record (EHR) datasets are increasingly used to facilitate research on growth, but measurement and recording errors can lead to biased results. We developed and tested an automated method for identifying implausible values in pediatric EHR growth data. Materials and Methods: Using deidentified data from 46 primary care sites, we developed an algorithm to identify weight and height values that should be excluded from analysis, including implausible values and values that were recorded repeatedly without remeasurement...
April 26, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28444652/-establishment-of-specialized-pediatric-palliative-home-care-in-the-medical-valley-of-the-european-metropolitan-area-nuremberg
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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