Use of Best Practice Alerts to Improve Adherence to Evidence-Based Screening in Pediatric Diabetes Care

Background: Youth with type 1 diabetes (T1D) are at increased risk for comorbid autoimmune conditions and long-term complications. To help with early identification of these complications, the American Diabetes Association (ADA) has published evidence-based screening guidelines. The aim of our quality improvement intervention was to improve and sustain adherence to the ADA recommended screening guidelines to \u3e90% for youth with T1D in the Texas Children’s Hospital (TCH) Diabetes Center by utilizing best practice alerts (BPA) within the electronic medical record (EMR). Methods: In accordance with the ADA Standards of Care screening guidelines for youth with T1D, we analyzed the database of TCH patients to obtain the following baseline percentages: 1) urine microalbumin-to-creatinine ratio, 2) thyroid function screen, 3) lipid panel, and 4) retinopathy screen. In the TCH EMR, we developed BPAs to alert providers and provide decision support on ADA-based screening recommendations at each clinic encounter. Comparisons were made to screening rates for each category pre- and post-intervention. Results: In the four years following the BPA build, the screening percentage for each category improved from a baseline of 90%, which has been maintained for three consecutive fiscal years. Conclusions: The use of EMR-based BPAs to alert providers of the need for evidenced-based screening is effective in increasing adherence to standard of care guidelines. With this quality improvement intervention, we achieved our goal of \u3e90% for each category. Similar tools for decision support may be effectively utilized for evidence-based screening in other disease states

Dihedral Quintic Fields with a Power Basis

It is shown that there exist infinitely many dihedral quintic fields with a power basis.</p

Elliptic Curves y²=x³-px of Rank Two

A class of prime numbers p is given for which the elliptic curve y² =x³-px has rank two. This extends a theorem of Kudo and Motose.</p

A NEW CAVE-DWELLING TENEBRIONID FROM JAVA (COL.)

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Dingo destruction 3 —The annual habits of dingoes in northern pastoral areas

While the basic principles of poisoning and trapping are the same throughout the State, there are differences in technique in various localities which are largely based on the annual habits of dogs in those areas. It is hoped that the information contained in this article will assist pas t oral is ts and others who are interested in the control of wild dogs throughout the northern pastoral areas