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pediatric "electronic health records"

Cassandra C Brady, Vidhu V Thaker, Todd Lingren, Jessica G Woo, Stephanie S Kennebeck, Bahram Namjou-Khales, Ashton Roach, Jonathan P Bickel, Nandan Patibandla, Guergana K Savova, Imre Solti, Ingrid A Holm, John B Harley, Isaac S Kohane, Nancy A Crimmins
Background and Objectives. The prevalence of severe obesity in children has doubled in the past decade. The objective of this study is to identify the clinical documentation of obesity in young children with a BMI ≥ 99th percentile at two large tertiary care pediatric hospitals. Methods. We used a standardized algorithm utilizing data from electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile at age <6 years). We extracted descriptive terms and ICD-9 codes to evaluate documentation of obesity at Boston Children's Hospital and Cincinnati Children's Hospital and Medical Center between 2007 and 2014...
2016: International Journal of Pediatrics
Derek J Williams, Yuwei Zhu, Carlos G Grijalva, Wesley H Self, Frank E Harrell, Carrie Reed, Chris Stockmann, Sandra R Arnold, Krow K Ampofo, Evan J Anderson, Anna M Bramley, Richard G Wunderink, Jonathan A McCullers, Andrew T Pavia, Seema Jain, Kathryn M Edwards
BACKGROUND: Substantial morbidity and excessive care variation are seen with pediatric pneumonia. Accurate risk-stratification tools to guide clinical decision-making are needed. METHODS: We developed risk models to predict severe pneumonia outcomes in children (<18 years) by using data from the Etiology of Pneumonia in the Community Study, a prospective study of community-acquired pneumonia hospitalizations conducted in 3 US cities from January 2010 to June 2012...
September 29, 2016: Pediatrics
Milos Jovanovic, Sandro Radovanovic, Milan Vukicevic, Sven Van Poucke, Boris Delibasic
OBJECTIVES: Quantification and early identification of unplanned readmission risk have the potential to improve the quality of care during hospitalization and after discharge. However, high dimensionality, sparsity, and class imbalance of electronic health data and the complexity of risk quantification, challenge the development of accurate predictive models. Predictive models require a certain level of interpretability in order to be applicable in real settings and create actionable insights...
September 2016: Artificial Intelligence in Medicine
Juan D Chaparro, David C Classen, Melissa Danforth, David C Stockwell, Christopher A Longhurst
OBJECTIVE: To evaluate the safety of computerized physician order entry (CPOE) and associated clinical decision support (CDS) systems in electronic health record (EHR) systems at pediatric inpatient facilities in the US using the Leapfrog Group's pediatric CPOE evaluation tool. METHODS: The Leapfrog pediatric CPOE evaluation tool, a previously validated tool to assess the ability of a CPOE system to identify orders that could potentially lead to patient harm, was used to evaluate 41 pediatric hospitals over a 2-year period...
September 16, 2016: Journal of the American Medical Informatics Association: JAMIA
Wayne Dickey, David R Arday, Joseph Kelly, Col David Carnahan
BACKGROUND AND PURPOSE: As childhood obesity is a concern in many communities, this study investigated outpatient evaluation and initial management of overweight and obese pediatric patients in U.S. military medical treatment facilities (MTFs). METHODS: Samples of 579 overweight and 341 obese patients (as determined by body mass index [BMI]) aged 3-17 years were drawn from MTFs. All available FY2011 outpatient records were searched for documentation of BMI assessment, overweight/obesity diagnosis, and counseling...
September 1, 2016: Journal of the American Association of Nurse Practitioners
A G Hirsch, J Pollak, T A Glass, M N Poulsen, L Bailey-Davis, J Mowery, B S Schwartz
BACKGROUND: Antibiotic use in early life has been linked to disruptions in the microbiome. Such changes can disturb immune system development. Differences have been observed in the microbiota of children with and without allergies, but there have been few studies on antibiotic use and allergic disease. OBJECTIVE: We evaluated associations of early-life antibiotic use with subsequent occurrence of food allergy and other allergies in childhood using electronic health record data...
August 26, 2016: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
Kenrick D Cato, Walter Bockting, Elaine Larson
Widespread availability of electronic health records coupled with sophisticated statistical methods offer great potential for a variety of applications for health and disease surveillance, developing predictive models and advancing decision support for clinicians. However, use of "big data" mining and discovery techniques has also raised ethical issues such as how to balance privacy and autonomy with the wider public benefits of data sharing. Furthermore, electronic data are being increasingly used to identify individual characteristics, which can be useful for clinical prediction and management, but were not previously disclosed to a clinician...
July 2016: Journal of Empirical Research on Human Research Ethics: JERHRE
Rachel Boykan, Carolyn Milana, Grace Propper, Patricia Bax, Paula Celestino
OBJECTIVES: (1) To implement a new policy-driven referral program, Opt-to-Quit, using electronic data transfer from the electronic health record (EHR) to the New York State Smokers' Quitline (NYSSQL) and (2) to improve referrals to the NYSSQL for smoking caregivers of children admitted to a children's hospital. METHODS: Smoking caregivers of pediatric patients were referred to the NYSSQL through a standardized template built into the EHR, during the child's hospitalization or emergency department encounter...
September 2016: Hospital Pediatrics
Christoph P Hornik, Daniel K Benjamin, P Brian Smith, Michael J Pencina, Adriana H Tremoulet, Edmund V Capparelli, Jessica E Ericson, Reese H Clark, Michael Cohen-Wolkowiez
OBJECTIVE: To evaluate the relationship between ampicillin dosing, exposure, and seizures. STUDY DESIGN: This was a retrospective observational cohort study of electronic health record (EHR) data combined with pharmacokinetic model derived drug exposure predictions. We used the EHR from 348 Pediatrix Medical Group neonatal intensive care units from 1997 to 2012. We included all infants 24-41 weeks gestational age, 500-5400 g birth weight, first exposed to ampicillin prior to 25 days postnatal age...
August 10, 2016: Journal of Pediatrics
Marta A King, Carrie A Phillipi, Paula M Buchanan, Linda O Lewin
OBJECTIVE: The written history and physical exam (H&P) is an underutilized source of medical trainee assessment. The authors describe development and validity evidence for Pediatric History and Physical Exam Evaluation (P-HAPEE) rubric: a novel tool for evaluating written H&Ps. METHODS: Through an iterative process, the authors drafted, revised, and implemented the 10-item rubric at three academic institutions in 2014. Eighteen attending physicians and 5 senior residents each scored 10 3(rd) year medical student H&Ps...
August 10, 2016: Academic Pediatrics
B Randall Brenn, Dinesh K Choudhry, Karen Sacks, Sandra Como-Fluehr, Robert Strain
OBJECTIVE: Despite increased focus on pediatric pain, uncontrolled pain is still a problem for hospitalized pediatric inpatients. A program was designed to find patients with uncontrolled pain and develop a framework to oversee their pain management. This report details the development of a pain stewardship program with data from the first year of its activity. METHODS: Hospitalized inpatients in a tertiary care pediatric center in the mid-Atlantic region were included in the study...
September 2016: Hospital Pediatrics
Nam K Tran, Zachary R Godwin, Amanda N Steele, Steven E Wolf, Tina L Palmieri
OBJECTIVES: The goal of this study was to retrospectively evaluate the clinical impact of an accurate autocorrecting blood glucose monitoring system in children with severe burns. Blood glucose monitoring system accuracy is essential for providing appropriate intensive insulin therapy and achieving tight glycemic control in critically ill patients. Unfortunately, few comparison studies have been performed to evaluate the clinical impact of accurate blood glucose monitoring system monitoring in the high-risk pediatric burn population...
September 2016: Pediatric Critical Care Medicine
Onur Asan, Richard J Holden, Kathryn E Flynn, Yushi Yang, Laila Azam, Matthew C Scanlon
OBJECTIVES: The purpose of this study was to explore providers' perspectives on the use of a novel technology, "Large Customizable Interactive Monitor" (LCIM), a novel application of the electronic health record system implemented in a Pediatric Intensive Care Unit. METHODS: We employed a qualitative approach to collect and analyze data from pediatric intensive care physicians, pediatric nurse practitioners, and acute care specialists. Using semi-structured interviews, we collected data from January to April, 2015...
2016: Applied Clinical Informatics
Todd Lingren, Vidhu Thaker, Cassandra Brady, Bahram Namjou, Stephanie Kennebeck, Jonathan Bickel, Nandan Patibandla, Yizhao Ni, Sara L Van Driest, Lixin Chen, Ashton Roach, Beth Cobb, Jacqueline Kirby, Josh Denny, Lisa Bailey-Davis, Marc S Williams, Keith Marsolo, Imre Solti, Ingrid A Holm, John Harley, Isaac S Kohane, Guergana Savova, Nancy Crimmins
OBJECTIVE: The objective of this study is to develop an algorithm to accurately identify children with severe early onset childhood obesity (ages 1-5.99 years) using structured and unstructured data from the electronic health record (EHR). INTRODUCTION: Childhood obesity increases risk factors for cardiovascular morbidity and vascular disease. Accurate definition of a high precision phenotype through a standardize tool is critical to the success of large-scale genomic studies and validating rare monogenic variants causing severe early onset obesity...
2016: Applied Clinical Informatics
Matthew W Miller, Rachael K Ross, Christina Voight, Heather Brouwer, Dean J Karavite, Jeffrey S Gerber, Robert W Grundmeier, Susan E Coffin
OBJECTIVE: To describe the use of digital images captured by parents or guardians and sent to clinicians for assessment of wounds after pediatric ambulatory surgery. METHODS: Subjects with digital images of post-operative wounds were identified as part of an on-going cohort study of infections after ambulatory surgery within a large pediatric healthcare system. We performed a structured review of the electronic health record (EHR) to determine how digital images were documented in the EHR and used in clinical care...
2016: Applied Clinical Informatics
Benjamin D Traun, Tracy L Flood, Amy Meinen, Mike Daniels, Patrick L Remington
IMPORTANCE: Over the past 3 decades, rates of childhood obesity have tripled. Given the gravity of this health concern, it is important that physicians intervene early. However, physicians continue to underdiagnose and undertreat childhood overweight and obesity. OBJECTIVE: The aim of this pilot study was to identify current tools and strategies used by pediatricians in regard to childhood obesity, as well as to reassess barriers to success, and to uncover areas for improvement...
June 2016: WMJ: Official Publication of the State Medical Society of Wisconsin
Eric Tham, Marguerite Swietlik, Sara Deakyne, Jeffrey M Hoffman, Robert W Grundmeier, Marilyn D Paterno, Beatriz H Rocha, Molly H Schaeffer, Deepika Pabbathi, Evaline Alessandrini, Dustin Ballard, Howard S Goldberg, Nathan Kuppermann, Peter S Dayan
INTRODUCTION: For children who present to emergency departments (EDs) due to blunt head trauma, ED clinicians must decide who requires computed tomography (CT) scanning to evaluate for traumatic brain injury (TBI). The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated two age-based prediction rules to identify children at very low risk of clinically-important traumatic brain injuries (ciTBIs) who do not typically require CT scans. In this case report, we describe the strategy used to implement the PECARN TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) as the intervention in a multicenter clinical trial...
2016: Applied Clinical Informatics
Brian P Jenssen, Eric D Shelov, Christopher P Bonafide, Steven L Bernstein, Alexander G Fiks, Tyra Bryant-Stephens
OBJECTIVES: To create and evaluate the feasibility, acceptability, and usability of a clinical decision support (CDS) tool within the electronic health record (EHR) to help pediatricians provide smoking cessation counseling and treatment to parents of hospitalized children exposed to secondhand smoke (SHS). METHODS: Mixed method study of first-year pediatric residents on one inpatient unit. Residents received training in smoking cessation counseling, nicotine replacement therapy (NRT) prescribing, and use of a CDS tool to aid in this process...
2016: Applied Clinical Informatics
Judy Rashotte, Lara Varpio, Kathy Day, Craig Kuziemsky, Avi Parush, Pat Elliott-Miller, James W King, Tyson Roffey
INTRODUCTION: Members of the healthcare team must access and share patient information to coordinate interprofessional collaborative practice (ICP). Although some evidence suggests that electronic health records (EHRs) contribute to in-team communication breakdowns, EHRs are still widely hailed as tools that support ICP. If EHRs are expected to promote ICP, researchers must be able to longitudinally study the impact of EHRs on ICP across communication types, users, and physical locations...
September 2016: International Journal of Medical Informatics
Ayelet Talmi, Emily F Muther, Kate Margolis, Melissa Buchholz, Ryan Asherin, Maya Bunik
OBJECTIVE: The current study examines the scope of integrated behavioral health services provided by behavioral health clinicians in pediatric primary care. METHODS: A cross-sectional electronic health record review was conducted to characterize integrated behavioral health services including consultation types, recommendations, and medical diagnoses. Services were provided over a 6-year period in an urban, residency-training clinic serving a primarily publicly insured population...
July 17, 2016: Journal of Pediatric Psychology
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