The Year 2000 Problem: An Ethical View

After years of avoidance, many organizations are struggling to make their computer systems year 2000 compliant. There is little question thatmeeting the year 2000 challenge is important from a business perspective since the survival of organizations may depend on it. However, a second, more neglected concern is whether system developers and their organizations have an ethical obligation to address the year 2000 problem. This paper examines three codes of ethics for information systems professionals to draw conclusions about this issue

Electronic Data Interchange: Guidelines for Development, Implementation, & Use

Electronic Data Interchange (EDI)provides new and expanded methods for communications between business partners. EDI is the inter-organizational transmission of business transactions in a standard format. With EDI, companies can bypass the traditional methods of sending physical documents, and instead send electronic ones. EDI is a form of communication that promises increased productivity. The original aims of EDI were to reduce cycle time and replace paper with electronically transmitted documents between trading partners (Figure 1). But, the contribution of EDI to business has grown beyond the goals of paperless high-speed communications. EDI is transforming entire industries. ATM networks and electronic-funds-transfer systems have altered the way we bank and trade securities. Now EDI is changing the face of retailing, supplier/customer relations, international trade, and many other areas. EDI represents an opportunity to directly improve business processes and business controls. Traditionally, organizations have used paper forms such as acknowledgements, orders, inquiries, checks, and the like to exchange information. But large volumes of paper-based exchanges created problems because they are slow and require extensive human handling. Many organizations have realized the importance offinding a more expedient way to communicate and process business data. There were 21,000 registered EDI users in 1991. In 1993, Data Interchange Standards Association, Inc. (DISA) reported that 37,000 companies were using EDI in the USA. Internationally,Singapore and Hong Kong both regard EDI as an important source of competitive advantage in trade. Australian Custom Service also uses EDI to communicate with European countries. Technically, there are few barriers to implementing EDI. The implementation of EDI is more a management problem; because, to really do it properly requires a complete rethinking of organizational structure, processes, procedures, and methods of doing business. This paper identifies several important issues associated with EDI development, implementation, and use. These factors, which include EDI technical considerations and implementation strategies, can serve as guidelines for organizations contemplating the use of EDI

Obesity does not affect early outcomes in children with newly diagnosed Crohn disease

The impact of obesity on pediatric Crohn disease (CD) remains poorly characterized. We aimed to evaluate disease-related outcomes in overweight and obese children with CD, compared to normal-weight children. We conducted a retrospective cohort study of children with newly diagnosed CD enrolled in the ImproveCareNow Network. Patients were stratified into normal weight, overweight, and obese groups using standardized weight percentiles. A total of 898 children were included, with 87 children (10%) being overweight and 43 children (5%) being obese; baseline characteristics were similar between groups. There was no significant difference in number of visits in remission during 1 year between normal weight, overweight, and obese children. At 1-year follow-up, nutritional status, growth status, or medication use also did not differ between groups. Hence, obesity does not appear to adversely affect CD outcomes in children with newly diagnosed CD in the first year after diagnosis

Race Differences in Initial Presentation, Early Treatment, and 1-year Outcomes of Pediatric Crohnʼs Disease: Results from the ImproveCareNow Network

BACKGROUND: Racially disparate care has been shown to contribute to suboptimal health care outcomes for minorities. Using the ImproveCareNow network, we investigated differences in management and outcomes of pediatric patients with Crohn's disease at diagnosis and 1-year postdiagnosis. METHODS: ImproveCareNow is a learning health network for pediatric inflammatory bowel disease. It contains prospective, longitudinal data from outpatient encounters. This retrospective study included all patients with Crohn's disease ≤21 years, September 2006 to October 2014, with the first recorded encounter ≤90 days from date of diagnosis and an encounter 1 year ±60 days. We examined the effect of race on remission rate and treatment at diagnosis and 1 year from diagnosis using t-tests, Wilcoxon rank-sum tests, χ statistic, and Fisher's exact tests, where appropriate, followed by univariate regression models. RESULTS: Nine hundred seventy-six patients (Black = 118 (12%), White = 858 (88%), mean age = 13 years, 63% male) from 39 sites were included. Black children had a higher percentage of Medicaid insurance (44% versus 11%, P < 0.001). At diagnosis, Black children had more active disease according to physician global assessment (P = 0.027), but not by short Pediatric Crohn's Disease Activity Index (P = 0.67). Race differences in treatment were not identified. Black children had lower hematocrit (34.8 versus 36.7, P < 0.001) and albumin levels (3.6 versus 3.9, P = 0.001). At 1 year, Black children had more active disease according to physician global assessment (P = 0.016), but not by short Pediatric Crohn's Disease Activity Index (P = 0.06). CONCLUSIONS: Black children with Crohn's disease may have more severe disease than White children based on physician global assessment. Neither disease phenotype differences at diagnosis nor treatment differences at 1-year follow-up were identified

Crohn's and Colitis Foundation of America Partners Patient-Powered Research Network

Background: To build a Patient-Powered Research Networks (PPRN) that prioritizes the needs of its members who have inflammatory bowel diseases (IBD), we sought to better understand patients' preferences for what are the essential features that will facilitate and sustain engagement. Methods: We conducted a two-phase qualitative study. Seven focus groups involving 62 participants with IBD were conducted (phase 1). Focus group results informed the phase 2 cognitive interviews, which included 13 phone interviews. Topics included experiences with IBD and research, PPRN engagement, patient-generated health data, and resources/tools to facilitate self-management. All focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed in ATLAS.ti 7.5. Thematic categories were derived from the data, and codes were grouped into emergent themes and relationships. Results: Four major themes emerged through inductive coding: (1) the impact of knowing; (2) participation barriers and challenges; (3) engagement and collaboration; and (4) customizable patient portal features/functionalities. Participants were motivated to participate in the PPRN because the knowledge gained from research studies would benefit both society and the individual. Main concerns included credibility of online resources, pharmaceutical industry profiting from their data, data security, and participation expectations. Participants wanted a true and equal partnership in every phase of building a PPRN. Participants felt it was important to have access to personal health records and be able to track health status and symptoms. Conclusion: Partnering with participants throughout PPRN development was critical to understanding the needs and preferences of patients with IBDs and for shaping engagement strategies and the portal's design

Multicenter evaluation of emergency department treatment for children and adolescents with Crohn's disease according to race/ethnicity and insurance payor status

Background Racial and socioeconomic disparities exist in the treatment and outcomes of children and adults with Crohn's disease (CD). This study investigated the impact of race and insurance status on emergency department (ED) evaluation and treatment among children with CD in the United States. Methods Data from the Pediatric Health Information System included ED visits between January 2007 and December 2013 for patients aged ó21 years with a primary diagnosis of CD, or a secondary diagnosis of CD plus a primary CD-related diagnosis. Analyses were performed using mixed-effects logistic regression. Results Subjects included 2618 unique patients (black, 612 [23%]; white, 2006 [77%]) with 3779 visits from 38 hospitals, a median age of 14.0 ñ 4.0 years, and 50% male. White children had a higher median neighborhood income and were more likely to have private insurance (57% vs 30%; P < 0.001). Emergency department visits for privately insured patients had higher odds of complete blood count (odds ratio [OR], 1.43; 95% CI, 1.08-1.90) and C-reactive protein/erythrocyte sedimentation rate (OR, 1.39; 95% CI, 1.06-1.82) vs Medicaid insured. Visits for white children had higher odds of receiving antiemetics (OR, 1.52; 95% CI, 1.06-2.17) vs black children. The proportion of patients with repeat visits was greater for black children (33%) than white children (22%; P < 0.001) and greater for Medicaid-insured (27%) than privately insured patients (21%; P < 0.01). Conclusions This cross-sectional database study demonstrated that black children and those with Medicaid insurance made more ED visits and received somewhat fewer treatments, which may be explained by greater use of the ED for routine care. An opportunity exists for better outpatient management of children with IBD so that nonemergent problems are more effectively handled

Racial Disparities in Readmission, Complications, and Procedures in Children with Crohnʼs Disease:

Racial disparities in care and outcomes contribute to mortality and morbidity in children however the role in pediatric Crohn’s disease (CD) is unclear. In this study, we compared cohorts of Black and White children with CD to determine the extent race is associated with differences in readmissions, complications, and procedures among hospitalizations in the United States

Prevalence of Eosinophilic Esophagitis in the United States

Eosinophilic esophagitis (EoE) has become a major cause of upper gastrointestinal morbidity in children and adults. However, there are few data on the nationwide prevalence of EoE. We aimed to estimate the prevalence of EoE in the United States (US)

Risk of venous thromboembolism in children after general surgery

Background/purpose: The purpose of the study was to determine absolute and relative rates of venous thromboembolism (VTE) following general surgical procedures in children compared to the general population. Methods: We analyzed data from all patients under the age of 18 years in the Clinical Practice Research Datalink, linked to Hospital Episode Statistics from England (2001–2011) undergoing a general surgical procedure and population controls. Crude rates of VTE and adjusted hazard ratios were calculated using Cox regression. Results We identified 15,637 children who had a surgical procedure with 161,594 controls. Six children undergoing surgery had a VTE diagnosed in the year after compared to five children in the population cohort. The overall rate of VTE following surgery was 0.4 per 1000 person years (pyrs) (95% confidence interval [CI] 0.15–0.88) compared to 0.04 per 1000 pyrs (95% CI 0.02–0.09) in the population cohort. This represented a 9 fold increase in risk compared to the population cohort (adjusted hazard ratio [HR] 8.80; 95% CI 2.59–29.94). Conclusions Children are at increased risk for VTE following general surgical procedures compared to the general population however the absolute risk is small and given this the benefits of thromboprophylaxis need to be balanced against the risk of complications following its use