Adoption of Electronic Medical Record-Based Decision Support for Otitis Media in Children

Substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use clinical decision support (CDS) to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media (OM) CDS system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence

A survey of informatics approaches to whole-exome and whole-genome clinical reporting in the electronic health record

Genome-scale clinical sequencing is being adopted more broadly in medical practice. The National Institutes of Health developed the Clinical Sequencing Exploratory Research (CSER) program to guide implementation and dissemination of best practices for the integration of sequencing into clinical care. This study describes and compares the state of the art of incorporating whole-exome and whole-genome sequencing results into the electronic health record, including approaches to decision support across the six current CSER sites

Teaching and Learning of Calculus

This survey focuses on the main trends in the field of calculus education. Despite their variety, the findings reveal a cornerstone issue that is strongly linked to the formalism of calculus concepts and to the difficulties it generates in the learning and teaching process. As a complement to the main text, an extended bibliography with some of the most important references on this topic is included. Since the diversity of the research in the field makes it difficult to produce an exhaustive state-of-the-art summary, the authors discuss recent developments that go beyond this survey and put forward new research questions

CSER and eMERGE: current and potential state of the display of genetic information in the electronic health record

Objective Clinicians’ ability to use and interpret genetic information depends upon how those data are displayed in electronic health records (EHRs). There is a critical need to develop systems to effectively display genetic information in EHRs and augment clinical decision support (CDS)

Trends in Vaccine Refusal and Acceptance Using Electronic Health Records from a Large Pediatric Hospital Network, 2013–2020: Strategies for Change

Understanding trends in vaccine refusal is critical to monitor as small declines in vaccination coverage can lead to outbreaks of vaccine-preventable diseases. Using electronic heath record (EHR) data from the Children’s Hospital of Philadelphia’s 31 outpatient primary care sites, we created a cohort of 403,448 children less than age 20 years who received at least one visit from 1 January 2013 through 31 December 2020. The sample represented 1,449,061 annualized patient and 181,131 annualized preventive vaccination visits per year. We characterized trends in vaccine refusal and acceptance using a repeated cross-sectional observational analysis of electronic health records (EHR) data using a single annual merged observation measure for patients seen multiple times for preventive healthcare within a calendar year. Refusals were identified for 212,900 annualized patient-visit year observations, which represented 14.6% of annualized patient-visit year observations and 25.1% of annualized vaccine patient-year observations. The odds of having a refusal marker were significantly increased in patients seen in suburban practices (aOR [CI]: 2.35 [2.30–2.40, p < 0.001]), in patients with increased age 11–17 years (aOR [CI]: 3.85 [3.79–3.91], p < 0.001), and those eligible for the VFC program (aOR [CI]: 1.10 [1.08–1.11]. Parental refusal (61.0%) and provider decisions (32.0%) were the most common documented in progress notes for not administering vaccines, whereas contraindications (2.5%) and supply issues (1.8%) were the least common. When offered, vaccine acceptance increased for human papillomavirus, hepatitis B, measles-mumps-rubella-containing and varicella-containing vaccines and decreased for hepatitis A and meningococcal vaccines. Repeated offering of vaccines was central to increasing acceptance, in part due to increased opportunities to address specific concerns

Hosta rectifolia Nakai

原著和名: タチギバウシ科名: ユリ科 = Liliaceae採集地: 北海道 幌泉郡 えりも町 百人浜 (北海道 日高 幌泉郡 えりも町 百人浜)採集日: 1987/8/31採集者: 萩庭丈壽整理番号: JH003452国立科学博物館整理番号: TNS-VS-95345

Clinic Characteristics Are not Associated with the Risk of Healthcare-associated Influenza-like Illness (HA-ILI) Among Young Children in Pediatric Primary Care Settings

Abstract Background: The majority of pediatric healthcare encounters for influenza-like illness (ILI) take place in ambulatory settings where there may be multiple opportunities for respiratory virus transmission. Recent evidence shows that a prior clinic visit increases the risk of ILI among young children. We hypothesized that clinic factors would be associated with the risk of HA-ILI among children 2 years) were combined to create a 5 category composite variable. Logistic regression models after applying sampling weights evaluated associations between HA-ILI risk and patient age, daycare / school attendance, gender, influenza vaccine receipt and waiting room patient density. Results: Our cohort included 367 HA-ILI cases and 941 non-cases. The majority (48.6%) were ≤2 years and did not attend school, 52.8% were male, and 18.9% received flu vaccine. Mean clinic patient density was 44.2 patients/1,000 square feet. In multivariable models, only the young age/daycare attendance composite variable was significantly associated with increased HA-ILI risk (OR 2.06, 95% CI 1.48,2.88). No clinic characteristics were associated with HA-ILI risk and risk did not vary by site. Conclusion: In our cohort of young children, HA-ILI was not associated with the measured clinic characteristics that we hypothesized may increase respiratory virus transmission risk. Instead HA-ILI risk was highest in young daycare attendees who may be more likely to engage in behaviors that increase respiratory virus exposure risk or seek out healthcare services when sick. This suggests that HA-ILI may be more strongly influenced by behavioral factors rather than environmental factors. Disclosures All authors: No reported disclosures