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pediatric "electronic health records"

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https://www.readbyqxmd.com/read/29912272/evaluating-statistical-approaches-to-leverage-large-clinical-datasets-for-uncovering-therapeutic-and-adverse-medication-effects
#1
Leena Choi, Robert J Carroll, Cole Beck, Jonathan D Mosley, Dan M Roden, Joshua C Denny, Sara L Van Driest
Motivation: Phenome-wide association studies (PheWAS) have been used to discover many genotype-phenotype relationships and have the potential to identify therapeutic and adverse drug outcomes using longitudinal data within electronic health records (EHRs). However, the statistical methods for PheWAS applied to longitudinal EHR medication data have not been established. Results: In this study, we developed methods to address two challenges faced with reuse of EHR for this purpose: confounding by indication, and low exposure and event rates...
April 18, 2018: Bioinformatics
https://www.readbyqxmd.com/read/29895740/kids-safe-and-smokefree-kiss-multilevel-intervention-to-reduce-child-tobacco-smoke-exposure-long-term-results-of-a-randomized-controlled-trial
#2
Stephen J Lepore, Bradley N Collins, Donna L Coffman, Jonathan P Winickoff, Uma S Nair, Beth Moughan, Tyra Bryant-Stephens, Daniel Taylor, David Fleece, Melissa Godfrey
BACKGROUND: Pediatricians following clinical practice guidelines for tobacco intervention (“Ask, Advise, and Refer” [AAR]) can motivate parents to reduce child tobacco smoke exposure (TSE). However, brief clinic interventions are unable to provide the more intensive, evidence-based behavioral treatments that facilitate the knowledge, skills, and confidence that parents need to both reduce child TSE and quit smoking. We hypothesized that a multilevel treatment model integrating pediatric clinic-level AAR with individual-level, telephone counseling would promote greater long-term (12-month) child TSE reduction and parent smoking cessation than clinic-level AAR alone...
June 12, 2018: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29894447/corrected-qt-interval-prolongation-in-hospitalized-pediatric-patients-receiving-methadone
#3
Amy J Schwinghammer, Machelle D Wilson, Brent A Hall
OBJECTIVES: Methadone is often used in pediatric patients to prevent or treat opioid withdrawal after prolonged sedation. Prolonged corrected QT interval is an important adverse effect of methadone because it can progress to torsades de pointes, a potentially fatal dysrhythmia. The prevalence of corrected QT interval prolongation and contributing risk factors are not well defined in hospitalized pediatric patients receiving methadone. The study purpose was to identify the frequency and risk factors of corrected QT interval prolongation in hospitalized pediatric patients receiving methadone...
June 11, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29893624/developmental-disorders-and-medical-complications-among-infants-with-subclinical-intrauterine-opioid-exposures
#4
Eric S Hall, Jennifer M McAllister, Scott L Wexelblatt
The objective was to compare diagnosis rates representing developmental outcomes and medical complications between infants with intrauterine opioid exposures who did not receive pharmacologic treatment for neonatal abstinence syndrome at the time of birth and infants for whom no exposure to substances of abuse were detected. This retrospective, descriptive study included approximately 95% of Hamilton County, Ohio resident births in 2014 and 2015. Universal maternal drug test results, performed at the time of birth, were documented and linked to electronic health records representing pediatric primary and subspecialty follow-up care as well as urgent care, emergency care, and inpatient services provided by Cincinnati Children's Hospital Medical Center through 2017, when all children were at least 24 months old...
June 12, 2018: Population Health Management
https://www.readbyqxmd.com/read/29888088/using-a-bedside-interactive-technology-to-solicit-and-record-pediatric-pain-reassessments-parent-and-nursing-perspectives-on-a-novel-workflow
#5
Raniah N Aldekhyyel, Genevieve B Melton, Gretchen Hultman, Michael B Pitt
To measure the impact of a novel interactive inpatient pediatric pain management solution integrating our hospital's electronic health record system, the nurse communication phones, and the pharmacy dispensing system, we assessed parent and nurse perspectives on the tool's potential value, benefits, and challenges. A mixed-methods approach with survey instruments containing closed-ended and open-ended questions was administered to 30 parents and 59 nurses (66% and 23% response rate respectively). Overall, parents were more satisfied with the interactive technology experience (90%) compared to nurses (50%) with both indicating timely reassessments of pain being the most valuable feature...
2018: AMIA Summits on Translational Science Proceedings
https://www.readbyqxmd.com/read/29883623/modeling-asynchronous-event-sequences-with-rnns
#6
Stephen Wu, Sijia Liu, Sunghwan Sohn, Sungrim Moon, Chung-Il Wi, Young Juhn, Hongfang Liu
Sequences of events have often been modeled with computational techniques, but typical preprocessing steps and problem settings do not explicitly address the ramifications of timestamped events. Clinical data, such as is found in electronic health records (EHRs), typically comes with timestamp information. In this work, we define event sequences and their properties: synchronicity, evenness, and co-cardinality; we then show how asynchronous, uneven, and multi-cardinal problem settings can support explicit accountings of relative time...
June 5, 2018: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/29880578/accuracy-of-administrative-codes-for-distinguishing-positive-pressure-ventilation-from-high-flow-nasal-cannula
#7
Ryan J Good, Matthew K Leroue, Angela S Czaja
OBJECTIVES: Noninvasive positive pressure ventilation (NIPPV) is increasingly used in critically ill pediatric patients, despite limited data on safety and efficacy. Administrative data may be a good resource for observational studies. Therefore, we sought to assess the performance of the International Classification of Diseases, Ninth Revision procedure code for NIPPV. METHODS: Patients admitted to the PICU requiring NIPPV or heated high-flow nasal cannula (HHFNC) over the 11-month study period were identified from the Virtual PICU System database...
June 7, 2018: Hospital Pediatrics
https://www.readbyqxmd.com/read/29859575/pediatric-anosmia-a-case-series
#8
Leah J Hauser, Emily L Jensen, David M Mirsky, Kenny H Chan
INTRODUCTION: Little is known about the etiology of olfactory dysfunction in the pediatric population. The aim of this study is to characterize the etiology and clinical features of anosmia and to explore evaluation options in a pediatric population. METHODS: Olfactory dysfunction was identified at a tertiary pediatric hospital between January 2003 and October 2014 using a text-based and ICD-9 search of the electronic health record system. Clinical information gathered included history, physical examination and imaging study...
July 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29851669/common-use-of-stimulants-and-alpha-2-agonists-to-treat-preschool-attention-deficit-hyperactivity-disorder-a-dbpnet-study
#9
Nathan J Blum, Justine Shults, Elizabeth Harstad, Susan Wiley, Marilyn Augustyn, Jareen K Meinzen-Derr, Mark L Wolraich, William J Barbaresi
OBJECTIVE: To describe the use of stimulants and alpha-2 agonists (A2As) for the treatment of preschool-aged children with attention-deficit hyperactivity disorder (ADHD) at 2 Developmental-Behavioral Pediatrics Research Network sites. METHODS: Demographic information, diagnoses, and medications prescribed by developmental-behavioral pediatricians (DBPs) were extracted from the electronic health record for all outpatient visits from January 1, 2010, to December 31, 2011...
May 30, 2018: Journal of Developmental and Behavioral Pediatrics: JDBP
https://www.readbyqxmd.com/read/29806185/electronic-health-record-ehr-based-postmarketing-surveillance-of-adverse-events-associated-with-pediatric-off-label-medication-use-a-case-study-of-short-acting-beta-2-agonists-and-arrhythmias
#10
Angela S Czaja, Michelle E Ross, Weiwei Liu, Alexander G Fiks, Russell Localio, Richard C Wasserman, Robert W Grundmeier, William G Adams
PURPOSE: Use electronic health record (EHR) data to (1) estimate the risk of arrhythmia associated with inhaled short-acting beta-2 agonists (SABA) in pediatric patients and (2) determine whether risk varied by on-label versus off-label prescribing. METHODS: Retrospective cohort study of 335 041 children ≤18 years using EHR primary care data from 2 pediatric health systems (2011-2013). A series of monthly pseudotrials were created, using propensity score methodology to balance baseline characteristics between SABA-exposed (identified by prescription) and SABA-unexposed children...
May 27, 2018: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/29791930/the-pediatric-emergency-care-applied-research-network-registry-a-multicenter-electronic-health-record-registry-of-pediatric-emergency-care
#11
Sara J Deakyne Davies, Robert W Grundmeier, Diego A Campos, Katie L Hayes, Jamie Bell, Evaline A Alessandrini, Lalit Bajaj, James M Chamberlain, Marc H Gorelick, Rene Enriquez, T Charles Casper, Beth Scheid, Marlena Kittick, J Michael Dean, Elizabeth R Alpern
BACKGROUND:  Electronic health record (EHR)-based registries allow for robust data to be derived directly from the patient clinical record and can provide important information about processes of care delivery and patient health outcomes. METHODS:  A data dictionary, and subsequent data model, were developed describing EHR data sources to include all processes of care within the emergency department (ED). ED visit data were deidentified and XML files were created and submitted to a central data coordinating center for inclusion in the registry...
April 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/29747644/electronic-health-record-tools-to-assist-with-children-s-insurance-coverage-a-mixed-methods-study
#12
Jennifer E DeVoe, Megan Hoopes, Christine A Nelson, Deborah J Cohen, Aleksandra Sumic, Jennifer Hall, Heather Angier, Miguel Marino, Jean P O'Malley, Rachel Gold
BACKGROUND: Children with health insurance have increased access to healthcare and receive higher quality care. However, despite recent initiatives expanding children's coverage, many remain uninsured. New technologies present opportunities for helping clinics provide enrollment support for patients. We developed and tested electronic health record (EHR)-based tools to help clinics provide children's insurance assistance. METHODS: We used mixed methods to understand tool adoption, and to assess impact of tool use on insurance coverage, healthcare utilization, and receipt of recommended care...
May 10, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29738270/association-between-pediatric-asthma-care-quality-and-morbidity-and-english-language-proficiency-in-ohio
#13
Martha P Montgomery, Elizabeth D Allen, Olivia Thomas, Byron F Robinson, Donnie Clark, Ann Connelly, Joshua A Mott, Elizabeth Conrey
OBJECTIVE: Limited English proficiency can be a barrier to asthma care and is associated with poor outcomes. This study examines whether pediatric patients in Ohio with limited English proficiency experience lower asthma care quality or higher morbidity. METHODS: We used electronic health records for asthma patients aged 2-17 years from a regional, urban, children's hospital in Ohio during 2011-2015. Community-level demographics were included from U.S. Census data...
May 8, 2018: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/29732457/a-computable-definition-of-sepsis-facilitates-screening-and-performance-improvement-tracking
#14
Lauren J Alessi, Holly R Warmus, Erin K Schaffner, Sajel Kantawala, Joseph Carcillo, Johanna Rosen, Christopher M Horvat
Background: Sepsis kills almost 5,000 children annually, accounting for 16% of pediatric health care spending in the United States. Objectives: We sought to identify sepsis within the Electronic Health Record (EHR) of a quaternary children's hospital to characterize disease incidence, improve recognition and response, and track performance metrics. Methods: Methods are organized in a plan-do-study-act cycle. During the "plan" phase, electronic definitions of sepsis (blood culture and antibiotic within 24 hours) and septic shock (sepsis plus vasoactive medication) were created to establish benchmark data and track progress with statistical process control...
March 2018: Pediatric Quality & Safety
https://www.readbyqxmd.com/read/29688461/transition-to-a-new-electronic-health-record-and-pediatric-medication-safety-lessons-learned-in-pediatrics-within-a-large-academic-health-system
#15
Kimberly Whalen, Emily Lynch, Iman Moawad, Tanya John, Denise Lozowski, Brian M Cummings
Objective: While the electronic health record (EHR) has become a standard of care, pediatric patients pose a unique set of risks in adult-oriented systems. We describe medication safety and implementation challenges and solutions in the pediatric population of a large academic center transitioning its EHR to Epic. Methods: Examination of the roll-out of a new EHR in a mixed neonatal, pediatric and adult tertiary care center with staggered implementation. We followed the voluntarily reported medication error rate for the neonatal and pediatric subsets and specifically monitored the first 3 months after the roll-out of the new EHR...
April 23, 2018: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29672356/improving-documentation-of-inpatient-problem-list-in-electronic-health-record-a-quality-improvement-project
#16
Prabi Rajbhandari, Moises Auron, Sarah Worley, Michelle Marks
BACKGROUND: The problem list is critical in electronic documentation. It is a powerful tool for clinical decision-making because it provides a concise view of all patient problems in one place and is also a criterion for the Medicare meaningful use incentive program. OBJECTIVE: To measure the rate of utilization of problem list in electronic health records (EHR) in a pediatric hospital medicine unit and implement sequential interventions to increase the rate of use of problem list to more than 80% by the end of 2015, as measured by at least one documented hospital problem at discharge...
April 19, 2018: Journal of Patient Safety
https://www.readbyqxmd.com/read/29661609/assessing-the-effect-of-an-educational-intervention-on-nurses-and-patient-care-assistants-comprehension-and-documentation-of-functional-ability-in-pediatric-patients-with-sickle-cell-disease
#17
Katherine M Bernier, Megan Strobel, Ruth Lucas
PURPOSE: In 2014, the Youth Acute Pain Functional Ability Questionnaire (YAPFAQ) was developed to investigate patient's self-rated functional ability during times of acute pain in the inpatient clinical setting. Although it has great potential, the application of this tool has not been made a standard of care. The purpose of this multiple methods study was to determine if, through an educational intervention, hospital staff could consistently document the YAPFAQ in children with sickle cell disease (SCD) during a vaso-occlusive episode...
April 13, 2018: Journal of Pediatric Nursing
https://www.readbyqxmd.com/read/29659856/integration-of-physical-abuse-clinical-decision-support-into-the-electronic-health-record-at-a-tertiary-care-children-s-hospital
#18
Srinivasan Suresh, Richard A Saladino, Janet Fromkin, Emily Heineman, Tom McGinn, Rudolph Richichi, Rachel P Berger
Objective: To evaluate the effect of a previously validated electronic health record-based child abuse trigger system on physician compliance with clinical guidelines for evaluation of physical abuse. Methods: A randomized controlled trial (RCT) with comparison to a preintervention group was performed. RCT-experimental subjects' providers received alerts with a direct link to a physical abuse-specific order set. RCT-control subjects' providers had no alerts, but could manually search for the order set...
April 12, 2018: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29650310/electronic-health-record-with-computerized-decision-support-tools-for-the-purposes-of-a-pediatric-cardiovascular-heart-disease-screening-program-in-crete
#19
Ilias Chatzakis, Kostas Vassilakis, Christos Lionis, Ioannis Germanakis
BACKGROUND AND OBJECTIVE: Early detection of cardiovascular (CV) disease or associated risk factors during childhood is of paramount importance, allowing for early treatment or lifestyle modifications, respectively. The objective of this study was to describe the development of an electronic health record (EHR), with integrated computerized decision support system (CDSS), specifically designed for supporting the needs of a pilot pediatric CV disease screening program applied on primary school students of a Mediterranean island...
June 2018: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/29629363/pediatric-vital-sign-distribution-derived-from-a-multi-centered-emergency-department-database
#20
Robert J Sepanski, Sandip A Godambe, Arno L Zaritsky
Background: We hypothesized that current vital sign thresholds used in pediatric emergency department (ED) screening tools do not reflect observed vital signs in this population. We analyzed a large multi-centered database to develop heart rate (HR) and respiratory rate centile rankings and z -scores that could be incorporated into electronic health record ED screening tools and we compared our derived centiles to previously published centiles and Pediatric Advanced Life Support (PALS) vital sign thresholds...
2018: Frontiers in Pediatrics
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