scholarly journals Suboptimal Clinical Documentation in Young Children with Severe Obesity at Tertiary Care Centers

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Cassandra C. Brady ◽  
Vidhu V. Thaker ◽  
Todd Lingren ◽  
Jessica G. Woo ◽  
Stephanie S. Kennebeck ◽  
...  
Keyword(s):  
Young Children ◽  
Early Onset ◽  
Severe Obesity ◽  
Medical Center ◽  
Tertiary Care ◽  
Clinical Documentation ◽  
Older Children ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
American Children

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.Results.A total of 9887 visit records of 2588 children with severe early onset obesity were identified. Based on predefined criteria for documentation of obesity, 21.5% of children (13.5% of visits) had positive documentation, which varied by institution. Documentation in children first seen under 2 years of age was lower than in older children (15% versus 26%). Documentation was significantly higher in girls (29% versus 17%,p<0.001), African American children (27% versus 19% in whites,p<0.001), and the obesity focused specialty clinics (70% versus 15% in primary care and 9% in other subspecialty clinics,p<0.001).Conclusions.There is significant opportunity for improvement in documentation of obesity in young children, even years after the 2007 AAP guidelines for management of obesity.

Utilization of Diagnostic Testing for Renal Anomalies and Congenital Heart Disease in Patients with Microtia

2020 ◽  
Vol 162 (4) ◽  
pp. 554-558
Author(s):  
Vaibhav H. Ramprasad ◽  
Amber D. Shaffer ◽  
Noel Jabbour
Keyword(s):  
Congenital Heart ◽  
Medical Center ◽  
Tertiary Care ◽  
Diagnostic Testing ◽  
Case Series ◽  
Standard Of Care ◽  
Renal Ultrasound ◽  
Renal Anomalies ◽  
Children's Hospital ◽  
Children’S Hospital

Objective Congenital ear anomalies are associated with congenital cardiac and renal defects. Renal ultrasounds, electrocardiogram, and echocardiogram can be utilized for diagnosis of these concurrent defects. No standard of care exists for the workup of patients with microtia. The goals of this study were to describe the utilization of diagnostic testing for cardiac and renal anomalies and to identify their prevalence in patients with microtia. Study Design Case series with chart review. Setting Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center. Subjects and Methods This study is an Institutional Review Board–approved retrospective review of consecutive patients born between 2002 and 2016 who were diagnosed with microtia and seen in the otolaryngology clinic at a tertiary care children’s hospital. Demographics, sidedness and grade of microtia, comorbid diagnoses, and details of renal and cardiovascular evaluations were recorded. Factors associated with retroperitoneal ultrasound and cardiac testing were assessed with logistic regression. Results Microtia was present in 102 patients, and 98 patients were included as they received follow-up. Microtia was associated with craniofacial syndrome in 34.7% of patients. Renal ultrasound was performed in 64.3% of patients, and 12.9% of patients with ultrasounds had renal aplasia. Cardiac workup (electrocardiogram or echocardiogram) was completed in 60.2% of patients, and of this subset, 54.2% had a congenital heart defect. Conclusion Diagnostic testing revealed renal anomalies and cardiac defects in patients with isolated microtia at a higher rate than in the general population. This suggests the need for further evaluation of the role of routine screening in patients with microtia.

Reduction in Rate of Nosocomial Respiratory Virus Infections in a Children’s Hospital Associated With Enhanced Isolation Precautions

2018 ◽  
Vol 39 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Lorry G. Rubin ◽  
Nina Kohn ◽  
Susan Nullet ◽  
Margaret Hill
Keyword(s):  
Respiratory Virus ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Medical Center ◽  
Tertiary Care ◽  
Virus Infections ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Respiratory Virus Infections ◽  
Hospital Days

OBJECTIVETo determine whether the use of enhanced isolation precautions (droplet and contact precautions) for inpatients with respiratory tract viral infections is associated with a reduction in rate of nosocomial viral respiratory infections.DESIGNQuasi-experimental study with the rate of nosocomial respiratory virus infection as the primary dependent variable and rate of nosocomialClostridium difficileinfection as a nonequivalent dependent variable comparator.SETTINGCohen Children’s Medical Center of NY, a tertiary-care children’s hospital attached to a large general hospital.INTERVENTIONDuring years 1 and 2 (July 2012 through June 2014), the Centers for Disease Control and Prevention/Healthcare Infection Control Practices Advisory Committee’s recommended isolation precautions for inpatients with selected respiratory virus infections were in effect. Enhanced isolation precautions were in effect during years 3 and 4 (July, 2014 through June, 2016), except for influenza, for which enhanced precautions were in effect during year 4 only.RESULTSDuring the period of enhanced isolation precautions, the rate of nosocomial respiratory virus infections with any of 4 virus categories decreased 39% from 0.827 per 1,000 hospital days prior to enhanced precautions to 0.508 per 1,000 hospital days (P<.0013). Excluding rhinovirus/enterovirus infections, the rates decreased 58% from 0.317 per 1,000 hospital days to 0.134 per 1,000 hospital days during enhanced precautions (P<.0014). During these periods, no significant change was detected in the rate of nosocomialC. difficileinfection.CONCLUSIONSEnhanced isolation precautions for inpatients with respiratory virus infections were associated with a reduction in the rate of nosocomial respiratory virus infections.Infect Control Hosp Epidemiol2018;39:152–156

Plasmodium vivaxmalaria admissions and risk of mortality in a tertiary-care children’s hospital in North India

2012 ◽  
Vol 32 (3) ◽  
pp. 152-157 ◽  
Author(s):  
Rajni Sharma ◽  
Suraj Gohain ◽  
Jagdish Chandra ◽  
Virendra Kumar ◽  
Abhishek Chopra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
North India ◽  
Children's Hospital ◽  
Risk Of Mortality ◽  
Children’S Hospital

An Association for Child Care in Hospitals

PEDIATRICS ◽  
1967 ◽  
Vol 40 (3) ◽  
pp. 471-472
Author(s):  
T. BERRY BRAZELTON
Keyword(s):  
Child Care ◽  
Patient Care ◽  
American Association ◽  
Medical Center ◽  
Total Patient ◽  
National Organization ◽  
Children's Hospital ◽  
The Past ◽  
Children’S Hospital ◽  
Initial Meeting

In the past 2 years a new national organization, called the American Association for Child Care in Hospitals, has evolved. This organization was initiated by the six "play ladies" who are in charge of the children's hospital programs in Baltimore, Boston, Cleveland, Montreal, Philadelphia, and Pittsburgh. Two years ago, the Children's Hospital Medical Center (CHMC) in Boston was host to 50 participants from these institutions to found the organization. This initial meeting was abetted by the CHMC's concern for total patient care and was made possible by the backing of the administration and the pediatric and psychiatric departments.

Analysis of the Effects of Applying Federal Diagnosis-Related Grouping (DRG) Guidelines to a Population of High-Risk Newborn Infants

PEDIATRICS ◽  
1985 ◽  
Vol 76 (1) ◽  
pp. 104-109
Author(s):  
Ronald L. Poland ◽  
Robert O. Bollinger ◽  
Mary P. Bedard ◽  
Sanford N. Cohen
Keyword(s):  
High Risk ◽  
Length Of Stay ◽  
Geometric Mean ◽  
Tertiary Care ◽  
Newborn Infants ◽  
Frequency Distributions ◽  
Federal Register ◽  
Children's Hospital ◽  
Lengths Of Stay ◽  
Children’S Hospital

Length of stay data collected for high-risk newborn infants admitted to a tertiary care children's hospital neonatal unit over a 6-year period were compared with mean and outlier lengths of stay published in the Federal Register as part of a proposed system for prospective payment of hospital cost by diagnosis-related groupings (DRGs). We found that the classification system for newborns markedly underestimated the number of days required for the treatment of these infants. The use of the geometric mean instead of the arithmetic mean as the measure of central tendency was a significant contributor to the discrepancy, especially in those sub-groups with bimodal frequency distributions of lengths of stay. Another contributor to the discrepancy was the lack of inborn patients in the children's hospital cohort. The system of prospective payments, as outlined, does not take into account several factors that have a strong influence on length of stay such as birth weight (which requires more than three divisions to serve as an effective predictor), surgery, outborn status, and ventilation. Implementation of the system described in the Federal Register would severely discourage tertiary care referral hospitals from providing neonatal intensive care.

THE URINARY MANIFESTATIONS OF ANXIETY IN CHILD

PEDIATRICS ◽  
1973 ◽  
Vol 52 (6) ◽  
pp. 818-822
Author(s):  
Richard Galdston ◽  
Alan D. Perlmutter
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Medical Center ◽  
Children's Hospital ◽  
Hospital Medical ◽  
Intrapsychic Conflict ◽  
Children’S Hospital ◽  
Psychiatric Manifestations

This report comprises concurrent studies of the urologic and psychiatric manifestations of intrapsychic conflict among a group of children who had been admitted to the surgical wards of The Children's Hospital Medical Center, Boston, between 1965 to 1970 for complaints of disordered urination. Experience with these children indicates that anxiety can alter the frequency and disturb the adequacy of voiding to a degree sufficient to dispose the child to urinary tract infection. This effect of anxiety can occur both in the presence or absence of a demonstrable anatomic lesion. It suggests that an assessment of the degree and nature of the child's anxiety should be an integral part of the pediatric urologic examination.

Indications for Naloxone in Lomotil Poisoning

PEDIATRICS ◽  
1974 ◽  
Vol 54 (5) ◽  
pp. 658-658
Author(s):  
Frederick H. Lovejoy
Keyword(s):  
Medical Center ◽  
Respiratory Effort ◽  
Narcotic Antagonist ◽  
Children's Hospital ◽  
Narcotic Antagonists ◽  
Hospital Medical ◽  
Comatose State ◽  
Children’S Hospital

Rumack and Temple in their thoughtful analysis of Lomotil poisoning1 note that narcotic antagonists should be used "as soon as adequate indications exist." From our experience with Lomotil toxicity in the last three years at Children's Hospital Medical Center and with other drugs producing narcotic like effects,2.3 we would like briefly to comment on the indications for the use of the narcotic antagonist, naloxone (Narcan) hydrochloride. Four prominent signs of naloxone efficacy exist: (1) dilatation of constricted pupils; (2) increase in depth and rate of respiratory effort; (3) reversal of hypotension; and (4) correction of an obtunded or comatose state.4

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