Using a computerized provider order entry system to meet the unique prescribing needs of children: description of an advanced dosing model

<p>Abstract</p> <p>Background</p> <p>It is well known that the information requirements necessary to safely treat children with therapeutic medications cannot be met with the same approaches used in adults. Over a 1-year period, Duke University Hospital engaged in the challenging task of enhancing an established computerized provider order entry (CPOE) system to address the unique medication dosing needs of pediatric patients.</p> <p>Methods</p> <p>An advanced dosing model (ADM) was designed to interact with our existing CPOE application to provide decision support enabling complex pediatric dose calculations based on chronological age, gestational age, weight, care area in the hospital, indication, and level of renal impairment. Given that weight is a critical component of medication dosing that may change over time, alerting logic was added to guard against erroneous entry or outdated weight information.</p> <p>Results</p> <p>Pediatric CPOE was deployed in a staggered fashion across 6 care areas over a 14-month period. Safeguards to prevent miskeyed values became important in allowing providers the flexibility to override the ADM logic if desired. Methods to guard against over- and under-dosing were added. The modular nature of our model allows us to easily add new dosing scenarios for specialized populations as the pediatric population and formulary change over time.</p> <p>Conclusions</p> <p>The medical needs of pediatric patients vary greatly from those of adults, and the information systems that support those needs require tailored approaches to design and implementation. When a single CPOE system is used for both adults and pediatrics, safeguards such as redirection and suppression must be used to protect children from inappropriate adult medication dosing content. Unlike other pediatric dosing systems, our model provides active dosing assistance and dosing process management, not just static dosing advice.</p

ImageSoil: a new database to boost explorations of the links between soil structure and soil functioning

International audienceSoil structure, whatever the scale, is a key element to understand soils functioning. The quantitative characterization of the pore network and its dynamics, together with soil organism activity and interactions with their environment, provides an understanding of the links between soil structure and functions (Konig et al., 2016, Porre et al. 2016). Cutting-edge imaging methods are thus increasingly needed and developed. They are diverse, from non-invasive (X-ray or neutron (micro)tomography) to destructive (optical, electronic, chemical microscopy…), in constant evolution, increasingly accessible, and produce always more data. It can be 2D or 3D images, time series images (to follow dynamic processes) or one-time images (to study the soil at a given time). To centralize these images in a unique information system, to facilitate and secure their storage along with their metadata, their publication and citation, and promote their sharing with the scientific community, we are building the ImageSoil database, which aims to be complementary to the Soil Structure Library (Weller et al., 2021. ImageSoil stores raw or processed images with i) their pedological metadata (sampling location and date, soil profile/horizon description…), ii) image acquisition metadata (image tools including beam characterization, pixel/voxel properties...), and iii) image analysis metadata (software, segmentation thresholds....). Soil images can also been linked through their metadata to National Information System storing soil properties. With ImageSoil, we aim to enable soils scientists worldwide to share their soil image data and promote further analyses of these newly available images, especially (but not exclusively) to answer questions requiring soil structure information