PMID- 18166618 OWN - NLM STAT- MEDLINE DA - 20080101 DCOM- 20080604 IS - 1526-3347 (Electronic) IS - 0191-9601 (Linking) VI - 29 IP - 1 DP - 2008 Jan TI - Index of suspicion. PG - 25-30 AD - Christiana Care Health System, Newark, Del., USA. FAU - Hall, Cherilyn AU - Hall C FAU - Friedland, Allen AU - Friedland A FAU - Sundar, Sumathi AU - Sundar S FAU - Torok, Kathryn S AU - Torok KS FAU - Bhende, Mananda S AU - Bhende MS FAU - Pecson, Grace AU - Pecson G FAU - Leedy, Carolyn AU - Leedy C LA - eng PT - Case Reports PT - Journal Article PL - United States TA - Pediatr Rev JT - Pediatrics in review / American Academy of Pediatrics JID - 8103046 SB - IM MH - Abdomen, Acute/*etiology MH - Adolescent MH - Anoxia/*etiology MH - Child MH - Diagnosis, Differential MH - Female MH - Heart Defects, Congenital/*diagnosis MH - Hematocolpos/*diagnosis MH - Humans MH - Hymen/*abnormalities MH - Infant MH - Intestinal Obstruction/*diagnosis MH - Intestinal Volvulus/*diagnosis MH - Intestines/*abnormalities MH - Male MH - Respiratory Insufficiency/*etiology EDAT- 2008/01/02 09:00 MHDA- 2008/06/05 09:00 CRDT- 2008/01/02 09:00 AID - 29/1/25 [pii] AID - 10.1542/pir.29-1-25 [doi] PST - ppublish SO - Pediatr Rev. 2008 Jan;29(1):25-30. PMID- 17466661 OWN - NLM STAT- MEDLINE DA - 20070430 DCOM- 20070522 IS - 1555-7162 (Electronic) IS - 0002-9343 (Linking) VI - 120 IP - 5 DP - 2007 May TI - Benchmarks for support of internal medicine-pediatrics programs. PG - 462-5 AD - Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. brett_robbins@urmc.rochester.edu FAU - Robbins, Brett W AU - Robbins BW FAU - Aronica, Michael AU - Aronica M FAU - Melgar, Thomas AU - Melgar T FAU - Friedland, Allen R AU - Friedland AR LA - eng PT - Journal Article PL - United States TA - Am J Med JT - The American journal of medicine JID - 0267200 SB - AIM SB - IM MH - *Benchmarking MH - Humans MH - Internal Medicine/*education MH - Internship and Residency/economics/*organization & administration/standards MH - Pediatrics/*education MH - Physician Executives MH - United States EDAT- 2007/05/01 09:00 MHDA- 2007/05/23 09:00 CRDT- 2007/05/01 09:00 PHST- 2006/08/15 [received] PHST- 2006/10/25 [revised] PHST- 2007/01/25 [accepted] AID - S0002-9343(07)00234-3 [pii] AID - 10.1016/j.amjmed.2007.01.027 [doi] PST - ppublish SO - Am J Med. 2007 May;120(5):462-5. PMID- 16981912 OWN - NLM STAT- Publisher DA - 20060919 IS - 1525-1497 (Electronic) IS - 0884-8734 (Linking) DP - 2006 Sep 18 TI - BRIEF REPORT: Health Care Provided by Program Directors to Their Resident Physicians and Families. AB - BACKGROUND: Who provides health care to resident physicians is not well studied. OBJECTIVE: To determine whether residency program directors (PDs) provide health care to their own residents and residents' families. DESIGN: An anonymous survey mailed to 1,345 PDs in Emergency Medicine, Family Medicine, Internal Medicine, Medicine-Pediatrics, and Obstetrics-Gynecology in the United States in 2003. RESULTS: Six hundred nineteen PDs (46%) responded. Half had taken care of their own residents for acute conditions. Less commonly, directors had written prescriptions for acute (40%) or chronic needs (15%) or provided ongoing care (22%). Only 3% believed this conflicted with their ability to be effective directors. Responders more likely to provide future care to residents considered this kind of care generally appropriate (P<.001), or appropriate under certain circumstances (P<.001). Most of these spent >/=31% of their time seeing patients. There was no difference among types of programs, gender of the director, or the years as director. Twenty-five percent of directors provided care to their residents' families. CONCLUSIONS: Substantial numbers of directors provided health care to their own residents. Few believed this conflicted with their director role. We believe organizations of PDs should develop positions about this practice. AD - Medicine-Pediatrics, Christiana Care Health System, Newark, DE, USA. AU - Friedland AR AU - Farber NJ AU - Collier VU LA - ENG PT - JOURNAL ARTICLE DEP - 20060918 TA - J Gen Intern Med JT - Journal of general internal medicine JID - 8605834 PMC - PMC1924733 EDAT- 2006/09/20 09:00 MHDA- 2006/09/20 09:00 CRDT- 2006/09/20 09:00 AID - JGI610 [pii] AID - 10.1111/j.1525-1497.2006.00610.x [doi] PST - aheadofprint SO - J Gen Intern Med. 2006 Sep 18. PMID- 12929331 OWN - NLM STAT- MEDLINE DA - 20030821 DCOM- 20031001 LR - 20041117 IS - 0011-7781 (Print) IS - 0011-7781 (Linking) VI - 75 IP - 6 DP - 2003 Jun TI - As the child with chronic disease grows up: transitioning adolescents with special health care needs to adult-centered health care. PG - 217-20 AB - The purpose of this article is to inform readers of the Delaware Medical Journal about the concept of transitional care for adolescents and young adults with chronic health care needs. This is a topic that has recently received national attention and was the subject of a supplement to Pediatrics in December 2002. The concept of transitional care bears special importance in Delaware as every year hundreds of children with chronic disease turn 18 and leave their pediatric providers. It is uncertain that these children resume their care with an adult health care provider, and there is almost always some lag in time as patients attempt to find an adult provider who is knowledgeable about their condition and willing to assume them as a patient. An even greater uncertainty is whether or not adult providers are prepared to take care of this new generation of adults with cyanotic congenital heart disease, spina bifida, cerebral palsy, and other conditions. This article explores some of these ideas and discusses what is available in the transition literature and where to go from here. AD - Committee on Transitions, A.I. duPont Hospital, USA. FAU - Bates, Kimberly AU - Bates K FAU - Bartoshesky, Louis AU - Bartoshesky L FAU - Friedland, Allen AU - Friedland A LA - eng PT - Journal Article PL - United States TA - Del Med J JT - Delaware medical journal JID - 0370077 SB - IM MH - Adolescent MH - Adolescent Health Services/*organization & administration MH - Adult MH - Child MH - Chronic Disease/*therapy MH - Continuity of Patient Care/*organization & administration MH - Delaware MH - Hospitals, Pediatric/organization & administration MH - Humans MH - Physician-Patient Relations MH - Professional Staff Committees/organization & administration MH - Professional-Family Relations EDAT- 2003/08/22 05:00 MHDA- 2003/10/02 05:00 CRDT- 2003/08/22 05:00 PST - ppublish SO - Del Med J. 2003 Jun;75(6):217-20. PMID- 12710116 OWN - NLM STAT- MEDLINE DA - 20030424 DCOM- 20030612 LR - 20041117 IS - 0825-8597 (Print) IS - 0825-8597 (Linking) VI - 19 IP - 1 DP - 2003 Spring TI - Using patients with cancer to educate residents about giving bad news. PG - 54-7 AD - Christiana Care Health System, Wilmington, Delaware, USA. FAU - Farber, Neil J AU - Farber NJ FAU - Friedland, Allen AU - Friedland A FAU - Aboff, Brian M AU - Aboff BM FAU - Ehrenthal, Deborah B AU - Ehrenthal DB FAU - Bianchetta, Tony AU - Bianchetta T LA - eng PT - Journal Article PL - Canada TA - J Palliat Care JT - Journal of palliative care JID - 8610345 SB - IM MH - Attitude of Health Personnel MH - *Communication MH - Humans MH - *Internship and Residency MH - Neoplasms/diagnosis/*psychology MH - Patient Care/*psychology/standards MH - Physician-Patient Relations MH - Questionnaires MH - *Truth Disclosure EDAT- 2003/04/25 05:00 MHDA- 2003/06/13 05:00 CRDT- 2003/04/25 05:00 PST - ppublish SO - J Palliat Care. 2003 Spring;19(1):54-7. PMID- 21640684 OWN - NLM STAT- In-Process DA - 20110909 IS - 1876-2867 (Electronic) VI - 11 IP - 5 DP - 2011 Sep-Oct TI - Graduating med-peds residents' interest in part-time employment. PG - 369-74 AB - OBJECTIVE: As part-time work is becoming more popular among the primary care specialties, we examined the demographic descriptors of med-peds residents seeking and finding part-time employment upon completion of residency training. METHODS: As part of the 2006 annual American Academy of Pediatrics (AAP) Graduating Med-Peds Residents Survey, we surveyed the graduating residents of all med-peds programs about their interest in and plans for part-time employment. A total of 199 (60%) of the residents responded. RESULTS: Of the resident respondents applying for nonfellowship jobs, 19% sought part-time positions and 10% actually accepted a part-time position. Female residents were significantly more likely than male residents to apply for part-time jobs (26% vs. 7%, P = .034). Sixty percent of female residents immediately seeking work and 58% of those going on to fellowship reported an interest in arranging a part-time or reduced-hours position at some point in the next 5 years. CONCLUSIONS: Part-time employment among med-peds residents applying for nonfellowship positions after graduation is similar to the current incidence of part-time employment in other fields of primary care. A much higher percentage of med-peds residents are interested in arranging part-time work within 5 years after graduation. This strong interest in part-time work has many implications for the primary care workforce. CI - Copyright (c) 2011 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved. AD - Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. brett_robbins@urmc.rochester.edu FAU - Fix, Amy L AU - Fix AL FAU - Kaelber, David C AU - Kaelber DC FAU - Melgar, Thomas A AU - Melgar TA FAU - Chamberlain, John AU - Chamberlain J FAU - Cull, William AU - Cull W FAU - Robbins, Brett W AU - Robbins BW LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110602 PL - United States TA - Acad Pediatr JT - Academic pediatrics JID - 101499145 SB - IM EDAT- 2011/06/07 06:00 MHDA- 2011/06/07 06:00 CRDT- 2011/06/07 06:00 PHST- 2010/07/27 [received] PHST- 2011/02/15 [revised] PHST- 2011/02/24 [accepted] PHST- 2011/06/02 [aheadofprint] AID - S1876-2859(11)00063-5 [pii] AID - 10.1016/j.acap.2011.02.013 [doi] PST - ppublish SO - Acad Pediatr. 2011 Sep-Oct;11(5):369-74. Epub 2011 Jun 2. PMID- 21151014 OWN - NLM STAT- In-Process DA - 20110426 IS - 1930-7381 (Print) IS - 1930-7381 (Linking) VI - 19 IP - 5 DP - 2011 May TI - Screening for obesity-related complications among obese children and adolescents: 1999-2008. PG - 1077-82 AB - Obesity is becoming an increasingly prevalent problem among American children. Screening for obesity associated comorbid conditions has been shown to be inconsistent. The current study was undertaken to explore patterns of ordering screening tests among obese pediatric patients. We analyzed electronic medical records (EMR) from 69,901 patients ages 2-18 years between June 1999 and December 2008. Obese children who had documented diagnoses of obesity were identified based on International Classification of Diseases, Ninth Revision codes. Screening rates for glucose, liver, and lipid abnormalities were assessed. Regression analysis was used to examine impact of patient characteristics and temporal trends were analyzed. Of the 9,251 obese diagnosed patients identified, 22% were screened for all three included obesity-related conditions: diabetes, liver, and lipid abnormalities; 52% were screened for glucose abnormalities; 30% for liver abnormalities; and 41% for lipid abnormalities. Increasing BMI and age were associated with increased rates of screening. Females and Hispanic patients were more likely to be screened. The majority of screening was ordered under "basic metabolic panel," "hepatic function panel," and "full lipid profile" for each respective condition. The percentages of patients screened generally increased over time, although the percentages screened for diabetes and lipid abnormalities seemed to plateau or decrease after 2004. Even after diagnosis, many obese patients are not receiving recommended laboratory screening tests. Screening increased during the study period, but remains less than ideal. Providers could improve care by more complete laboratory screening in patients diagnosed with obesity. AD - Denver Children's Hospital, Denver, Colorado, USA. benson.lacey@tchden.org FAU - Benson, Lacey J AU - Benson LJ FAU - Baer, Heather J AU - Baer HJ FAU - Kaelber, David C AU - Kaelber DC LA - eng PT - Journal Article DEP - 20101209 PL - United States TA - Obesity (Silver Spring) JT - Obesity (Silver Spring, Md.) JID - 101264860 SB - IM EDAT- 2010/12/15 06:00 MHDA- 2010/12/15 06:00 CRDT- 2010/12/15 06:00 PHST- 2010/12/09 [aheadofprint] AID - oby2010277 [pii] AID - 10.1038/oby.2010.277 [doi] PST - ppublish SO - Obesity (Silver Spring). 2011 May;19(5):1077-82. Epub 2010 Dec 9. PMID- 20626580 OWN - NLM STAT- MEDLINE DA - 20101020 DCOM- 20110216 IS - 1440-1754 (Electronic) IS - 1034-4810 (Linking) VI - 46 IP - 10 DP - 2010 Oct TI - When is family history obtained? - Lack of timely documentation of family history among overweight and hypertensive paediatric patients. PG - 600-5 LID - 10.1111/j.1440-1754.2010.01798.x [doi] AB - AIM: Taking a detailed family history is an inexpensive way for healthcare providers to screen patients for increased risk of various chronic conditions. Documentation of family history, however, has been shown to be incomplete in the majority of patient charts. The current study examines when family history is collected within the context of the development and diagnosis of chronic conditions in paediatrics, using hypertension and overweight/obesity as examples. METHODS: We analysed family history data from the electronic medical records of 5485 overweight/obese and 774 hypertensive children and adolescents in a large, urban medical system in northeast Ohio. Manual review of 200 charts was also performed. RESULTS: Family history information was entered prior to the development of hypertension in 13.5% of hypertensive patients with a family history of hypertension, and it was entered prior to the development of abnormal weight in 35.5% of overweight/obese patients with a family history of obesity or a related condition. Of patients with a relevant family history who received an actual diagnosis for either of these conditions, only 16.7% of hypertensive and 33.3% of overweight/obese patients had this family history documented prior to diagnosis. CONCLUSIONS: These results imply that paediatric providers may not use family history as a screening tool for assessing future risk of obesity and hypertension, but instead gather this information after these chronic conditions have developed, making it difficult to implement preventative or screening strategies based on familial risk. CI - (c) 2010 The Authors. Journal compilation (c) 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians). AD - The Children's Hospital, Denver, Colorado, USA. david.kaelber@case.edu FAU - Benson, Lacey AU - Benson L FAU - Baer, Heather J AU - Baer HJ FAU - Greco, Peter J AU - Greco PJ FAU - Kaelber, David C AU - Kaelber DC LA - eng PT - Journal Article PL - Australia TA - J Paediatr Child Health JT - Journal of paediatrics and child health JID - 9005421 SB - IM MH - Adolescent MH - Child MH - Child, Preschool MH - *Family MH - Humans MH - *Hypertension MH - Medical Audit MH - *Medical History Taking MH - Ohio MH - *Overweight MH - Pediatrics EDAT- 2010/07/16 06:00 MHDA- 2011/02/17 06:00 CRDT- 2010/07/15 06:00 AID - JPC1798 [pii] AID - 10.1111/j.1440-1754.2010.01798.x [doi] PST - ppublish SO - J Paediatr Child Health. 2010 Oct;46(10):600-5. doi: 10.1111/j.1440-1754.2010.01798.x. PMID- 19833670 OWN - NLM STAT- MEDLINE DA - 20091125 DCOM- 20100309 LR - 20100331 IS - 1741-2889 (Electronic) IS - 1367-4935 (Linking) VI - 13 IP - 4 DP - 2009 Dec TI - The association of continuity of care on the diagnosis of hypertension in children and adolescents. PG - 361-9 AB - Hypertension among pediatric patients is an underdiagnosed condition. As continuity of care has been found to increase quality of pediatric care, we undertook this study to assess effect of continuity on diagnosis of pediatric hypertension. This is a retrospective analysis of 774 hypertensive patients, ages 3-18 years between June 1999 and October 2007 within the MetroHealth System in northeastern Ohio. The proportion of hypertensive patients diagnosed was assessed using coding within the electronic medical record. Continuity was assessed using the usual provider of care, defined as the number of visits to the most frequent provider divided by the total number of visits in the study period. Overall continuity did not have a statistically significant association with diagnosis (OR 0.7, CI 0.4-1.4). Our research indicates that continuity does not significantly affect diagnosis of hypertension in pediatric patients. Other approaches should be investigated to improve the significant underdiagnosis of pediatric hypertension. AD - The Children's Hospital, Denver, CO, USA. FAU - Benson, Lacey J AU - Benson LJ FAU - Cohn, Robert AU - Cohn R FAU - Kaelber, David C AU - Kaelber DC LA - eng PT - Journal Article DEP - 20091015 PL - England TA - J Child Health Care JT - Journal of child health care : for professionals working with children in the hospital and community JID - 9806360 SB - N EIN - J Child Health Care. 2010 Mar;14(1):126 MH - Adolescent MH - Child MH - Child, Preschool MH - *Continuity of Patient Care MH - Humans MH - Hypertension/*diagnosis MH - Ohio MH - Retrospective Studies EDAT- 2009/10/17 06:00 MHDA- 2010/03/10 06:00 CRDT- 2009/10/17 06:00 PHST- 2009/10/15 [aheadofprint] AID - 1367493509344680 [pii] AID - 10.1177/1367493509344680 [doi] PST - ppublish SO - J Child Health Care. 2009 Dec;13(4):361-9. Epub 2009 Oct 15. PMID- 19414519 OWN - NLM STAT- MEDLINE DA - 20090601 DCOM- 20090617 IS - 1098-4275 (Electronic) IS - 0031-4005 (Linking) VI - 123 IP - 6 DP - 2009 Jun TI - Simple table to identify children and adolescents needing further evaluation of blood pressure. PG - e972-4 AB - OBJECTIVE: The goal was to create a tool to screen more easily for children and adolescents who might have hypertension or prehypertension. METHODS: We took the existing tables from The Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents, which contain hundreds of normal and abnormal blood pressure values based on gender, age, and height percentile, and analyzed this data to develop a much simplified table based only on gender and age. RESULTS: In our simplified table we reduced the number of values from 476 to 64 and have only one threshold value of abnormal systolic and diastolic blood pressure, by gender, for each year of life (ages 3 to > or =18). This table makes it easy to identify abnormal blood pressure values in almost any potential care or screening setting. This approach is ideal when blood pressure is measured outside a physician's office or even at intake in a pediatrician's office, when the height percentile (which is required for the use of current tables) may not be easily obtainable. CONCLUSIONS: This screening tool can quickly and easily identify children and adolescents whose blood pressure readings merit further evaluation by a physician and rule out abnormal blood pressure in children and adolescents. AD - Department of Pediatrics, MetroHealth System, Cleveland, Ohio, USA. david.kaelber@case.edu FAU - Kaelber, David C AU - Kaelber DC FAU - Pickett, Frieda AU - Pickett F LA - eng PT - Journal Article DEP - 20090504 PL - United States TA - Pediatrics JT - Pediatrics JID - 0376422 SB - AIM SB - IM MH - Adolescent MH - Age Factors MH - Blood Pressure Determination/statistics & numerical data MH - Child MH - Child, Preschool MH - Emergency Service, Hospital MH - Female MH - Humans MH - Hypertension/*diagnosis/epidemiology MH - Male MH - Mass Screening/*methods/statistics & numerical data MH - Pediatrics MH - Physicians' Offices MH - Reference Values MH - Sex Factors EDAT- 2009/05/06 09:00 MHDA- 2009/06/18 09:00 CRDT- 2009/05/06 09:00 PHST- 2009/05/04 [aheadofprint] AID - peds.2008-2680 [pii] AID - 10.1542/peds.2008-2680 [doi] PST - ppublish SO - Pediatrics. 2009 Jun;123(6):e972-4. Epub 2009 May 4. PMID- 19240455 OWN - NLM STAT- MEDLINE DA - 20090225 DCOM- 20090331 IS - 1938-808X (Electronic) IS - 1040-2446 (Linking) VI - 84 IP - 3 DP - 2009 Mar TI - Characteristics of medicine-pediatrics practices: results from the national ambulatory medical care survey. PG - 396-401 AB - BACKGROUND: Combined medicine-pediatrics (med-peds) training has existed for 40 years, yet little is known about national med-peds practices. A more comprehensive understanding of med-peds practices is important to inform medical students and guide evolving curricula and accreditation standards. METHOD: The authors used data from the National Ambulatory Medical Care Survey from 2000 to 2006 to characterize the age distribution and types of visits seen by med-peds, internal medicine, pediatric, and family physicians. RESULTS: Forty-three percent of visits to med-peds physicians were from children < or = 18 years of age. Compared with family physicians, med-peds physicians saw a higher proportion of infants and toddlers < or = 2 years of age (21.0% versus 3.7%; P = .002) and children < or = 18 years of age (42.9% versus 15.5%; P = .002), but they treated fewer adults age 65 or older (13.8% versus 21.3%; P = .013). Compared with internists, med-peds physicians saw a greater percentage of visits from adults 19 to 64 years of age (75.8% versus 61.2%) and fewer visits from patients age 65 or older (24.2% versus 38.8%; P = .006). Med-peds physicians, like family physicians and pediatricians, most commonly treated patients for acute problems and reported high levels of continuity of care for patients-pediatric (93.6%) and adult (94.6%). CONCLUSIONS: Med-peds physicians care for a considerable proportion of pediatric patients while maintaining high levels of continuity of care for adult and pediatric patients. Within their practices, med-peds physicians treat a larger percentage of pediatric patients than do family physicians, but they see a smaller percentage of elderly patients. AD - Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA. rfortuna@post.harvard.edu FAU - Fortuna, Robert J AU - Fortuna RJ FAU - Ting, David Y AU - Ting DY FAU - Kaelber, David C AU - Kaelber DC FAU - Simon, Steven R AU - Simon SR LA - eng GR - 5 T32 HP11001-18/PHS HHS/United States PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Acad Med JT - Academic medicine : journal of the Association of American Medical Colleges JID - 8904605 SB - AIM SB - IM MH - Adolescent MH - Adult MH - Age Distribution MH - Aged MH - Ambulatory Care/*organization & administration/statistics & numerical data MH - Child, Preschool MH - Health Care Surveys MH - Humans MH - Infant MH - Internal Medicine/*organization & administration/statistics & numerical data MH - Middle Aged MH - Office Visits/statistics & numerical data MH - Pediatrics/*organization & administration/statistics & numerical data MH - Primary Health Care/*organization & administration/statistics & numerical data MH - Professional Practice/*organization & administration/statistics & numerical data MH - United States MH - Young Adult EDAT- 2009/02/26 09:00 MHDA- 2009/04/01 09:00 CRDT- 2009/02/26 09:00 AID - 10.1097/ACM.0b013e3181970bb9 [doi] AID - 00001888-200903000-00032 [pii] PST - ppublish SO - Acad Med. 2009 Mar;84(3):396-401. PMID- 19117837 OWN - NLM STAT- MEDLINE DA - 20090101 DCOM- 20090206 IS - 1098-4275 (Electronic) IS - 0031-4005 (Linking) VI - 123 IP - 1 DP - 2009 Jan TI - Trends in the diagnosis of overweight and obesity in children and adolescents: 1999-2007. PG - e153-8 AB - OBJECTIVE: Pediatric overweight and obesity are increasingly prevalent problems and have received much attention in recent years, but it is unclear whether this publicity has affected diagnosis by clinicians. We undertook the current study to assess trends in diagnosis rates of overweight and obesity in children. PATIENTS AND METHODS: We analyzed electronic medical record data from 60711 patients aged 2 through 18 years with at least 1 well-child visit between June 1999 and October 2007 in a large academic medical system in northeast Ohio. Diagnosis of weight problems among children classified as overweight and obese was assessed by using International Classification of Diseases, Ninth Revision codes. Logistic regression was used to examine the impact of patient characteristics on diagnosis and to investigate trends over the study period. RESULTS: On retrospective review of BMI measurements recorded for patients during the study period, 19% of the children were overweight, 23% were obese, and 8% (33% of the obese patients) were severely obese; among these, 10% of overweight patients, 54% of obese patients, and 76% of severely obese patients had their conditions diagnosed. BMI, age, and number of overweight visits were positively associated with diagnosis. Female patients were more likely to have been diagnosed than male patients. Black and Hispanic patients were more likely to have been diagnosed than white patients. There was a statistically significant trend toward increasing diagnosis during the study period, although the percentage of patients diagnosed per year seemed to plateau or decrease after 2005. CONCLUSIONS: Although clear BMI definitions of pediatric weight problems exist, a large percentage of overweight and obese patients remain undiagnosed. Diagnosis increased during the study period but remained low among overweight children, for whom early intervention may be more effective. Identification of overweight and obese patients is the first step in addressing this growing epidemic. AD - School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA. FAU - Benson, Lacey AU - Benson L FAU - Baer, Heather J AU - Baer HJ FAU - Kaelber, David C AU - Kaelber DC LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - Pediatrics JT - Pediatrics JID - 0376422 SB - AIM SB - IM MH - Adolescent MH - Body Mass Index MH - Body Weight/physiology MH - Child MH - Child, Preschool MH - Cohort Studies MH - Delivery of Health Care/standards/*trends MH - Female MH - Humans MH - Male MH - Medical Records Systems, Computerized/standards/trends MH - Obesity/*diagnosis/epidemiology/physiopathology MH - Overweight/diagnosis/epidemiology/physiopathology MH - Retrospective Studies EDAT- 2009/01/02 09:00 MHDA- 2009/02/07 09:00 CRDT- 2009/01/02 09:00 AID - 123/1/e153 [pii] AID - 10.1542/peds.2008-1408 [doi] PST - ppublish SO - Pediatrics. 2009 Jan;123(1):e153-8. PMID- 18999276 OWN - NLM STAT- MEDLINE DA - 20081112 DCOM- 20100108 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) DP - 2008 TI - The value of personal health record (PHR) systems. PG - 343-7 AB - Personal health records (PHRs) are a rapidly growing area of health information technology despite a lack of significant value-based assessment.Here we present an assessment of the potential value of PHR systems, looking at both costs and benefits.We examine provider-tethered, payer-tethered, and third-party PHRs, as well as idealized interoperable PHRs. An analytical model was developed that considered eight PHR application and infrastructure functions. Our analysis projects the initial and annual costs and annual benefits of PHRs to the entire US over the next 10 years.This PHR analysis shows that all forms of PHRs have initial net negative value. However, at the end of 10 years, steady state annual net value ranging from$13 billion to -$29 billion. Interoperable PHRs provide the most value, followed by third-party PHRs and payer-tethered PHRs also showing positive net value. Provider-tethered PHRs constantly demonstrating negative net value. AD - Center for Information Technology Leadership (CITL), Partners HealthCare System, Boston, MA, USA. FAU - Kaelber, David AU - Kaelber D FAU - Pan, Eric C AU - Pan EC LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20081106 PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium JID - 101209213 SB - IM MH - Cost-Benefit Analysis MH - Health Care Costs/*statistics & numerical data MH - Health Records, Personal/*economics MH - Medical Records Systems, Computerized/*economics MH - *Models, Economic MH - United States PMC - PMC2655982 OID - NLM: PMC2655982 EDAT- 2008/11/13 09:00 MHDA- 2010/01/09 06:00 CRDT- 2008/11/13 09:00 PHST- 2008/03/14 [received] PHST- 2008/07/16 [revised] PST - epublish SO - AMIA Annu Symp Proc. 2008 Nov 6:343-7. PMID- 18998988 OWN - NLM STAT- MEDLINE DA - 20081112 DCOM- 20100108 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) DP - 2008 TI - A cost model for personal health records (PHRs). PG - 657-61 AB - Personal health records (PHRs) are a rapidly expanding area in medical informatics due to the belief that they may improve healthcare delivery and control costs of care. To truly understand the full potential value of a technology, a cost analysis is critical.However, little evidence exists on the value potential of PHRs, and a cost model for PHRs does not currently exist in the literature.This paper presents a sample cost model for PHR systems, which include PHR infrastructure and applications. We used this model to examine the costs of provider-tethered, payer-tethered, third-party, and interoperable PHRs. Our model projects that on a per-person basis, third-party PHRs will be the most expensive followed by inter operable PHRs, and then provider-tethered PHRs and payer-tethered PHRs are the least expensive. Data interfaces are a major cost driver, thus these findings underscore the need for standards development and use in the implementation ofPHR systems. AD - Center for Information Technology Leadership (CITL), Harvard Medical School, Boston, MA, USA. FAU - Shah, Sapna AU - Shah S FAU - Kaelber, David C AU - Kaelber DC FAU - Vincent, Adam AU - Vincent A FAU - Pan, Eric C AU - Pan EC FAU - Johnston, Douglas AU - Johnston D FAU - Middleton, Blackford AU - Middleton B LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20081106 PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium JID - 101209213 SB - IM MH - Computer Simulation MH - Health Care Costs/*statistics & numerical data MH - Massachusetts MH - Medical Records Systems, Computerized/*economics MH - *Models, Economic PMC - PMC2656035 OID - NLM: PMC2656035 EDAT- 2008/11/13 09:00 MHDA- 2010/01/09 06:00 CRDT- 2008/11/13 09:00 PHST- 2008/03/14 [received] PHST- 2008/07/16 [revised] PST - epublish SO - AMIA Annu Symp Proc. 2008 Nov 6:657-61. PMID- 18998912 OWN - NLM STAT- MEDLINE DA - 20081112 DCOM- 20100108 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) DP - 2008 TI - A patient-centric taxonomy for personal health records (PHRs). PG - 763-7 AB - Today, the nascent field of personal health records (PHRs) lacks a comprehensive taxonomy that encompasses the full range of PHRs currently in existence and what may be possible. The Center for Information Technology Leadership (CITL) has created a taxonomy that broadly defines a PHR as having both an infrastructure component, which allows for data viewing and sharing, and an application component, allowing for self-management and information exchange. The taxonomy also accounts for different PHR architectures provider, payer, third-party, or interoperable. This comprehensive taxonomy may help to define the field of PHRs and provide a framework for assessing PHR value. AD - Center for Information Technology Leadership (CITL), Partners HealthCare System, Harvard Medical School, Boston, MA, USA. FAU - Vincent, Adam AU - Vincent A FAU - Kaelber, David C AU - Kaelber DC FAU - Pan, Eric AU - Pan E FAU - Shah, Sapna AU - Shah S FAU - Johnston, Douglas AU - Johnston D FAU - Middleton, Blackford AU - Middleton B LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20081106 PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium JID - 101209213 SB - IM MH - Algorithms MH - Artificial Intelligence MH - Forms and Records Control/methods/*organization & administration MH - *Health Records, Personal MH - Information Storage and Retrieval/methods MH - Massachusetts MH - Medical History Taking/methods MH - Medical Records Systems, Computerized/*organization & administration MH - Natural Language Processing MH - Patient-Centered Care/methods/*organization & administration MH - Pattern Recognition, Automated/*methods MH - *Subject Headings PMC - PMC2656090 OID - NLM: PMC2656090 EDAT- 2008/11/13 09:00 MHDA- 2010/01/09 06:00 CRDT- 2008/11/13 09:00 PHST- 2008/03/13 [received] PHST- 2008/07/16 [revised] PST - epublish SO - AMIA Annu Symp Proc. 2008 Nov 6:763-7. PMID- 18756002 OWN - NLM STAT- MEDLINE DA - 20081103 DCOM- 20081209 LR - 20110801 IS - 1067-5027 (Print) IS - 1067-5027 (Linking) VI - 15 IP - 6 DP - 2008 Nov-Dec TI - A research agenda for personal health records (PHRs). PG - 729-36 AB - Patients, policymakers, providers, payers, employers, and others have increasing interest in using personal health records (PHRs) to improve healthcare costs, quality, and efficiency. While organizations now invest millions of dollars in PHRs, the best PHR architectures, value propositions, and descriptions are not universally agreed upon. Despite widespread interest and activity, little PHR research has been done to date, and targeted research investment in PHRs appears inadequate. The authors reviewed the existing PHR specific literature (100 articles) and divided the articles into seven categories, of which four in particular--evaluation of PHR functions, adoption and attitudes of healthcare providers and patients towards PHRs, PHR related privacy and security, and PHR architecture--present important research opportunities. We also briefly discuss other research related to PHRs, PHR research funding sources, and PHR business models. We believe that additional PHR research can increase the likelihood that future PHR system deployments will beneficially impact healthcare costs, quality, and efficiency. AD - Partners HealthCare Information Systems, Boston MA, USA. david.kaelber@case.edu FAU - Kaelber, David C AU - Kaelber DC FAU - Jha, Ashish K AU - Jha AK FAU - Johnston, Douglas AU - Johnston D FAU - Middleton, Blackford AU - Middleton B FAU - Bates, David W AU - Bates DW LA - eng PT - Journal Article DEP - 20080828 PL - United States TA - J Am Med Inform Assoc JT - Journal of the American Medical Informatics Association : JAMIA JID - 9430800 SB - IM MH - Attitude to Health MH - Confidentiality MH - *Health Services Research MH - Humans MH - Medical Records MH - *Medical Records Systems, Computerized MH - Patient Access to Records MH - Patient Participation PMC - PMC2585530 OID - NLM: PMC2585530 EDAT- 2008/08/30 09:00 MHDA- 2008/12/17 09:00 CRDT- 2008/08/30 09:00 PHST- 2008/08/28 [aheadofprint] AID - M2547 [pii] AID - 10.1197/jamia.M2547 [doi] PST - ppublish SO - J Am Med Inform Assoc. 2008 Nov-Dec;15(6):729-36. Epub 2008 Aug 28. PMID- 18694241 OWN - NLM STAT- MEDLINE DA - 20080812 DCOM- 20081118 LR - 20090309 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) DP - 2007 TI - A new taxonomy for telehealth technologies. PG - 1145 AB - Today, the field of telehealth lacks a comprehensive taxonomy that reflects the variety of remote interactions, technologies used, and personnel involved. The Center for Information Technology Leadership (CITL) has created a taxonomy that categorizes telehealth around four factors: type of telehealth interaction, location of the controlling medical authority, urgency of care, and timing of communication. This comprehensive taxonomy may help to define the field of telehealth and may help with adoption, research, and reimbursement. AD - Center for Information Technology Leadership (CITL), Partners HealthCare System, Boston, MA, USA. FAU - Vincent, Adam AU - Vincent A FAU - Cusack, Caitlin M AU - Cusack CM FAU - Pan, Eric AU - Pan E FAU - Hook, Julie M AU - Hook JM FAU - Kaelber, David C AU - Kaelber DC FAU - Middleton, Blackford AU - Middleton B LA - eng PT - Journal Article DEP - 20071011 PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium JID - 101209213 SB - IM MH - Telemedicine/*classification MH - Terminology as Topic EDAT- 2008/08/13 09:00 MHDA- 2008/11/19 09:00 CRDT- 2008/08/13 09:00 PHST- 2007/03/15 [received] PHST- 2007/07/31 [revised] PHST- 2007/10/11 [accepted] PST - epublish SO - AMIA Annu Symp Proc. 2007 Oct 11:1145. PMID- 18694099 OWN - NLM STAT- MEDLINE DA - 20080812 DCOM- 20081118 LR - 20090309 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) DP - 2007 TI - Ambulatory electronic medical record payback analysis 7 years after implementation in a tertiary care county medical system. PG - 1000 AB - Electronic medical records (EMRs) are gaining increasing prominence in healthcare, however still have low market penetration. EMR implementation cost is a primary perceived barrier. Here we present a payback analysis on an outpatient EMR implementation, showing capital expense recovery (net of operating costs) at 6 years and now generating $6 million yearly in direct savings for our healthcare system. AD - Center for Information Technology Leadership (CITL), Partners HealthCare System andHarvard Medical School, Boston, MA, USA. FAU - Kaelber, David C AU - Kaelber DC FAU - Miller, Vince AU - Miller V FAU - Fisher, Nancy AU - Fisher N FAU - Schlesinger, Jim AU - Schlesinger J FAU - Norris, Greg AU - Norris G LA - eng PT - Journal Article DEP - 20071011 PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium JID - 101209213 SB - IM MH - Academic Medical Centers/economics MH - Capital Expenditures MH - Medical Records Systems, Computerized/*economics MH - Organizational Case Studies MH - Organizational Innovation/economics EDAT- 2008/08/13 09:00 MHDA- 2008/11/19 09:00 CRDT- 2008/08/13 09:00 PHST- 2007/03/15 [received] PHST- 2007/07/31 [revised] PHST- 2007/10/11 [accepted] PST - epublish SO - AMIA Annu Symp Proc. 2007 Oct 11:1000. PMID- 18694066 OWN - NLM STAT- MEDLINE DA - 20080812 DCOM- 20081118 LR - 20090309 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) DP - 2007 TI - Underdiagnosis of pediatric hypertension-an example of a new era of clinical research enabled by electronic medical records. PG - 966 AB - Previously, large scale clinical research required large budgets, significant staff, and long periods of time. Typically most of these resources were spent on data collection to develop electronic research databases. With the proliferation of electronic medical records this clinical research paradigm changes. Here we present a large clinical study of pediatric hypertension (14,187 patients) conducted through an electronic medical record without any budget and within about 70 hours over 6 months. AD - Case Western Reserve University, Cleveland, OH, USA. FAU - Gunn, Paul W AU - Gunn PW FAU - Hansen, Matthew L AU - Hansen ML FAU - Kaelber, David C AU - Kaelber DC LA - eng PT - Journal Article DEP - 20071011 PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium JID - 101209213 SB - IM MH - Biomedical Research/*methods MH - Child MH - Diagnostic Errors MH - Humans MH - Hypertension/*diagnosis MH - Information Storage and Retrieval MH - *Medical Records Systems, Computerized MH - Practice Guidelines as Topic MH - Retrospective Studies EDAT- 2008/08/13 09:00 MHDA- 2008/11/19 09:00 CRDT- 2008/08/13 09:00 PHST- 2007/03/15 [received] PHST- 2007/07/31 [revised] PHST- 2007/10/11 [accepted] PST - epublish SO - AMIA Annu Symp Proc. 2007 Oct 11:966. PMID- 18693861 OWN - NLM STAT- MEDLINE DA - 20080812 DCOM- 20081118 LR - 20091118 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) DP - 2007 TI - A framework and approach for assessing the value of personal health records (PHRs). PG - 374-8 AB - Personal Health Records (PHRs) are a rapidly expanding area of medical informatics due to the belief that they may improve health care delivery and control costs of care. The PHRs in use or in development today support a myriad of different functions, and consequently offer different value propositions. A comprehensive value analysis of PHRs has never been conducted; such analysis is needed to identify those PHR functions that yield the greatest value to PHR stakeholders. Here we present a framework that could serve as a foundation for determining the value of PHR functions and thereby help optimize PHR development. While the value framework is specific to the domain of PHRs, the authors have successfully applied the associated evaluation methodology in assessing other health care information technologies. AD - Center for Information Technology Leadership (CITL), Partners HealthCare System, Boston, MA, USA. FAU - Johnston, Douglas AU - Johnston D FAU - Kaelber, David AU - Kaelber D FAU - Pan, Eric C AU - Pan EC FAU - Bu, Davis AU - Bu D FAU - Shah, Sapna AU - Shah S FAU - Hook, Julie M AU - Hook JM FAU - Middleton, Blackford AU - Middleton B LA - eng PT - Journal Article DEP - 20071011 PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium JID - 101209213 SB - IM MH - Communication MH - Decision Support Techniques MH - Humans MH - *Medical Records MH - *Medical Records Systems, Computerized MH - Patient Access to Records MH - Patient Participation MH - Self Care PMC - PMC2655849 OID - NLM: PMC2655849 EDAT- 2008/08/13 09:00 MHDA- 2008/11/19 09:00 CRDT- 2008/08/13 09:00 PHST- 2007/03/15 [received] PHST- 2007/07/20 [revised] PHST- 2007/10/11 [accepted] PST - epublish SO - AMIA Annu Symp Proc. 2007 Oct 11:374-8. PMID- 18578679 OWN - NLM STAT- MEDLINE DA - 20080626 DCOM- 20080717 IS - 1556-3669 (Electronic) IS - 1530-5627 (Linking) VI - 14 IP - 5 DP - 2008 Jun TI - The value of provider-to-provider telehealth. PG - 446-53 AB - Telehealth has great potential to improve access to care, but its adoption in routine healthcare has been slow. The lack of clarity about the value of telehealth implementations has been one reason cited for this slow adoption. The Center for Information Technology Leadership has examined the value of telehealth encounters in which there is a provider both with the patient and at a distance from the patient. We considered three models of telehealth: store-and-forward, real-time video, and hybrid systems. Evidence from the literature was extrapolated using a computer simulation, which found that the hybrid model was the most cost effective. The simulation predicted savings of $4.3 billion per year if hybrid telehealth systems were implemented in emergency rooms, prisons, nursing home facilities, and physician offices across the United States. We also conducted a sensitivity analysis to determine which factors most influence costs and savings. Payers, providers, and policymakers should work together to remove the barriers to the adoption of telehealth so that this cost savings can be realized in the U.S. healthcare system. AD - Division of General Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachussetts, USA. epan@partners.org FAU - Pan, Eric AU - Pan E FAU - Cusack, Caitlin AU - Cusack C FAU - Hook, Julie AU - Hook J FAU - Vincent, Adam AU - Vincent A FAU - Kaelber, David C AU - Kaelber DC FAU - Bates, David W AU - Bates DW FAU - Middleton, Blackford AU - Middleton B LA - eng PT - Journal Article PT - Review PL - United States TA - Telemed J E Health JT - Telemedicine journal and e-health : the official journal of the American Telemedicine Association JID - 100959949 SB - IM MH - Computer Simulation MH - Cost-Benefit Analysis MH - *Diffusion of Innovation MH - *Health Personnel MH - Humans MH - *Telemedicine MH - United States RF - 40 EDAT- 2008/06/27 09:00 MHDA- 2008/07/18 09:00 CRDT- 2008/06/27 09:00 AID - 10.1089/tmj.2008.0017 [doi] PST - ppublish SO - Telemed J E Health. 2008 Jun;14(5):446-53. PMID- 18534947 OWN - NLM STAT- MEDLINE DA - 20080606 DCOM- 20081014 IS - 1357-633X (Print) IS - 1357-633X (Linking) VI - 14 IP - 4 DP - 2008 TI - The value proposition in the widespread use of telehealth. PG - 167-8 AB - Telehealth has great potential to improve access to care but its adoption in routine health care has been slow. The lack of clarity about the value of telehealth implementations has been one reason cited for this slow adoption. The Center for Information Technology Leadership has examined the value of telehealth encounters in which there is a provider both with the patient and at a distance from the patient. We considered three models of telehealth: store-and-forward, real-time video and hybrid systems. Evidence from the literature was extrapolated using a simulation, which found that the hybrid model was the most cost-effective of the three. The simulation predicted savings of $4.3 billion per year if hybrid telehealth systems were to be implemented in emergency rooms, prisons, nursing home facilities and physician offices across the US. We also conducted a sensitivity analysis to determine which factors most affected costs and savings. For all three telehealth models, the highest sensitivities were to the cost of a face-to-face visit, the cost of a telehealth visit and the success rate of a telehealth visit, i.e. the proportion of telehealth visits that avoided the need for a face-to-face visit. Payers, providers and policy-makers should work together to remove the barriers to the adoption of telehealth in order to make it widely available to all. AD - Center for IT Leadership, Partners HealthCare, One Constitution Center, Charlestown, MA 02129, USA. FAU - Cusack, Caitlin M AU - Cusack CM FAU - Pan, Eric AU - Pan E FAU - Hook, Julie M AU - Hook JM FAU - Vincent, Adam AU - Vincent A FAU - Kaelber, David C AU - Kaelber DC FAU - Middleton, Blackford AU - Middleton B LA - eng PT - Journal Article PL - England TA - J Telemed Telecare JT - Journal of telemedicine and telecare JID - 9506702 SB - IM MH - Cost-Benefit Analysis MH - Delivery of Health Care/*economics/trends MH - Diffusion of Innovation MH - Health Services Accessibility/*economics/standards MH - Humans MH - Models, Statistical MH - Telemedicine/*economics/instrumentation MH - United States EDAT- 2008/06/07 09:00 MHDA- 2008/10/15 09:00 CRDT- 2008/06/07 09:00 AID - 14/4/167 [pii] AID - 10.1258/jtt.2007.007043 [doi] PST - ppublish SO - J Telemed Telecare. 2008;14(4):167-8. PMID- 17950041 OWN - NLM STAT- MEDLINE DA - 20071120 DCOM- 20080104 IS - 1532-0480 (Electronic) IS - 1532-0464 (Linking) VI - 40 IP - 6 Suppl DP - 2007 Dec TI - Health information exchange and patient safety. PG - S40-5 AB - One of the most promising advantages for health information exchange (HIE) is improved patient safety. Up to 18% of the patient safety errors generally and as many as 70% of adverse drug events could be eliminated if the right information about the right patient is available at the right time. Health information exchange makes this possible. Here we present an overview of six different ways in which HIE can improve patient safety-improved medication information processing, improved laboratory information processing, improved radiology information processing, improved communication among providers, improved communication between patients and providers, and improved public health information processing. Within the area of improved medication information processing we discuss drug-allergy information processing, drug-dose information processing, drug-drug information processing, drug-diagnosis information processing, and drug-gene information processing. We also briefly discuss HIE and decreased patient safety as well as standards and completeness of information for HIE and patient safety. AD - Center for Information Technology Leadership and Clinical and Quality Analysis, Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, MA 02115, USA. FAU - Kaelber, David C AU - Kaelber DC FAU - Bates, David W AU - Bates DW LA - eng PT - Journal Article PT - Review DEP - 20070907 PL - United States TA - J Biomed Inform JT - Journal of biomedical informatics JID - 100970413 SB - IM MH - *Consumer Product Safety MH - Information Dissemination/*methods MH - Information Systems/*organization & administration MH - Medical Informatics/*methods/*organization & administration MH - *Patient Rights MH - Program Evaluation/*methods MH - United States RF - 61 EDAT- 2007/10/24 09:00 MHDA- 2008/01/05 09:00 CRDT- 2007/10/24 09:00 PHST- 2007/08/15 [received] PHST- 2007/08/16 [accepted] PHST- 2007/09/07 [aheadofprint] AID - S1532-0464(07)00090-1 [pii] AID - 10.1016/j.jbi.2007.08.011 [doi] PST - ppublish SO - J Biomed Inform. 2007 Dec;40(6 Suppl):S40-5. Epub 2007 Sep 7. PMID- 17889081 OWN - NLM STAT- MEDLINE DA - 20070924 DCOM- 20071009 LR - 20091119 IS - 1097-6833 (Electronic) IS - 0022-3476 (Linking) VI - 151 IP - 4 DP - 2007 Oct TI - The effect of dual training in internal medicine and pediatrics on the career path and job search experience of pediatric graduates. PG - 419-24 AB - OBJECTIVE: To compare the job search experience and career plans of medicine-pediatrics (med-peds) and pediatric residents. STUDY DESIGN: Annual surveys of graduating med-peds and pediatric residents were compared from 2003 and 2004. RESULTS: The survey response rates were 58% for med-peds residents (n = 427) and 61% for pediatric residents (n = 611). Pediatric residents were more likely to be female or an International Medical Graduate. The groups were equally satisfied with their career choice and had equivalent debt. Med-peds residents were more likely to seek and accept generalist and hospitalist positions. Pediatric residents were more likely to seek subspecialty careers and research opportunities. More than 94% of med-peds residents expected to care for pediatric patients. Among residents seeking generalist positions, med-peds residents sent half as many applications to get the same number of interviews and offers as pediatric residents, were more likely to be offered their most desired position, and were more likely to accept a position in a rural area/small town. Med-peds residents had substantially greater starting salaries as hospitalists or generalists compared with pediatric residents. CONCLUSION: Med-peds and pediatric trainees differ in their career plans, although primary care is their most popular choice. Med-peds- trained physicians have an easier job search experience and greater market valuation. AD - Department of Internal Medicine, University of Rochester, Rochester, NY, USA. jkenneth@rochester.rr.com FAU - Chamberlain, John K AU - Chamberlain JK FAU - Cull, William L AU - Cull WL FAU - Melgar, Tom AU - Melgar T FAU - Kaelber, David C AU - Kaelber DC FAU - Kan, Brian D AU - Kan BD LA - eng PT - Comparative Study PT - Journal Article DEP - 20070823 PL - United States TA - J Pediatr JT - The Journal of pediatrics JID - 0375410 SB - AIM SB - IM CIN - J Pediatr. 2007 Oct;151(4):338-9. PMID: 17889064 MH - Adult MH - *Career Choice MH - Fellowships and Scholarships MH - Female MH - Health Care Surveys MH - Humans MH - Internal Medicine/*education MH - *Internship and Residency MH - Male MH - Medicine MH - Pediatrics/*education MH - *Personnel Selection MH - Salaries and Fringe Benefits MH - Specialization MH - United States EDAT- 2007/09/25 09:00 MHDA- 2007/10/10 09:00 CRDT- 2007/09/25 09:00 PHST- 2006/12/14 [received] PHST- 2007/03/12 [revised] PHST- 2007/04/26 [accepted] PHST- 2007/08/23 [aheadofprint] AID - S0022-3476(07)00441-6 [pii] AID - 10.1016/j.jpeds.2007.04.064 [doi] PST - ppublish SO - J Pediatr. 2007 Oct;151(4):419-24. Epub 2007 Aug 23. PMID- 17712071 OWN - NLM STAT- MEDLINE DA - 20070822 DCOM- 20070824 LR - 20080313 IS - 1538-3598 (Electronic) IS - 0098-7484 (Linking) VI - 298 IP - 8 DP - 2007 Aug 22 TI - Underdiagnosis of hypertension in children and adolescents. PG - 874-9 AB - CONTEXT: Pediatric hypertension is increasing in prevalence with the pediatric obesity epidemic. Diagnosis of hypertension in children is complicated because normal and abnormal blood pressure values vary with age, sex, and height and are therefore difficult to remember. OBJECTIVES: To determine the frequency of undiagnosed hypertension and prehypertension and to identify patient factors associated with this underdiagnosis. DESIGN, SETTING, AND PARTICIPANTS: A cohort study of 14,187 children and adolescents aged 3 to 18 years who were observed at least 3 times for well-child care between June 1999 and September 2006 in the outpatient clinics in a large academic urban medical system in northeast Ohio. For children and adolescents who met criteria for hypertension or prehypertension at 3 or more well-child care visits, the proportion with a hypertension-related International Classification of Diseases, Ninth Revision code in the diagnoses list, problem list, or past medical history list of any visit was determined. MAIN OUTCOME MEASURES: Proportion of children and adolescents with 3 or more elevated age-adjusted and height-adjusted blood pressure measurements at well-child care visits and with a diagnosis of hypertension or prehypertension documented in the electronic medical record. Multivariate logistic regression identified patient factors associated with a correct diagnosis. RESULTS: Of 507 children and adolescents (3.6%) who had hypertension, 131 (26%) had a diagnosis of hypertension or elevated blood pressure documented in the electronic medical record. Patient factors that increased the adjusted odds of a correct diagnosis were a 1-year increase in age over age 3 (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.03-1.16), number of elevated blood pressure readings beyond 3 (OR, 1.77; 95% CI, 1.21-2.57), increase of 1% in height-for-age percentile (OR, 1.02; 95% CI, 1.01-1.03), having an obesity-related diagnosis (OR, 2.61; 95% CI, 1.49-4.55), and number of blood pressure readings in the stage 2 hypertension range (OR, 1.68; 95% CI, 1.29-2.19). Of 485 children and adolescents (3.4%) who had prehypertension, 55 (11%) had an appropriate diagnosis documented in the electronic medical record. Patient factors that increased the adjusted odds of being diagnosed with prehypertension included a 1-year increase in age over age 3 (OR, 1.21; 95% CI, 1.09-1.34) and number of elevated blood pressure readings beyond 3 (OR, 3.07; 95% CI, 2.20-4.28). CONCLUSIONS: Hypertension and prehypertension were frequently undiagnosed in this pediatric population. Patient age, height, obesity-related diagnoses, and magnitude and frequency of abnormal blood pressure readings all increased the odds of diagnosis. AD - School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA. FAU - Hansen, Matthew L AU - Hansen ML FAU - Gunn, Paul W AU - Gunn PW FAU - Kaelber, David C AU - Kaelber DC LA - eng PT - Journal Article PL - United States TA - JAMA JT - JAMA : the journal of the American Medical Association JID - 7501160 SB - AIM SB - IM CIN - JAMA. 2008 Jan 9;299(2):168; author reply 168-9. PMID: 18182597 CIN - Nat Clin Pract Cardiovasc Med. 2008 Mar;5(3):128-9. PMID: 18059382 MH - Adolescent MH - Blood Pressure MH - Child MH - Child, Preschool MH - Cohort Studies MH - Female MH - Humans MH - Hypertension/*diagnosis/epidemiology MH - Logistic Models MH - Male MH - Reference Values MH - Risk Factors EDAT- 2007/08/23 09:00 MHDA- 2007/08/25 09:00 CRDT- 2007/08/23 09:00 AID - 298/8/874 [pii] AID - 10.1001/jama.298.8.874 [doi] PST - ppublish SO - JAMA. 2007 Aug 22;298(8):874-9. PMID- 17272092 OWN - NLM STAT- PubMed-not-MEDLINE DA - 20070202 DCOM- 20070918 IS - 1557-170X (Print) IS - 1557-170X (Linking) VI - 3 DP - 2004 TI - The next generation EKG--in vivo demonstration of noninvasive electrocardiographic imaging during normal sinus rhythm. PG - 1933-6 AB - Noninvasive, in vivo, reconstruction of epicardial electrical activity is needed to help better study, understand, and treat electrical rhythm abnormalities. Here, a new method for noninvasive electrocardiographic imaging is used to reconstruct epicardial potentials in vivo during normal sinus rhythm. This method used measured body surface potentials (BSPMs) and the relative geometry between the body surface and epicardial surface from computed tomography (CT) to reconstruct in vivo epicardial potentials during normal sinus rhythm. The reconstructed epicardial potentials correlated qualitatively with those expected for various aspects of normal sinus rhythm (NSR). This study shows that noninvasively reconstructed epicardial potentials could provide useful information on the electrical activity of the heart during normal activation and repolarization sequences not otherwise available. AD - Department of Internal Medicine, Case Western Reserve University, Cleveland, OH, USA. FAU - Kaelber, David C AU - Kaelber DC LA - eng PT - Journal Article PL - United States TA - Conf Proc IEEE Eng Med Biol Soc JT - Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference JID - 101243413 EDAT- 2007/02/03 09:00 MHDA- 2007/02/03 09:01 CRDT- 2007/02/03 09:00 AID - 10.1109/IEMBS.2004.1403572 [doi] PST - ppublish SO - Conf Proc IEEE Eng Med Biol Soc. 2004;3:1933-6. PMID- 17238608 OWN - NLM STAT- MEDLINE DA - 20070122 DCOM- 20070928 LR - 20090309 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) DP - 2006 TI - Assessing medical informatics confidence among 1st and 2nd year medical students. PG - 989 AB - Currently no medical informatics curriculum is required at US medical schools. In 1998 the Association of American Medical Colleges (AAMC) Medical School Objectives Project (MSOP) identified topics for inclusion in medical school curriculum, categorized in five domains: Life-Long Learner, Clinician, Educator/Communicator, Researcher, and Manager. Here we present the results of a web-based survey of 1st and 2nd year medical students at Case Western Reserve University (Case). The survey determined the perceived skills of 1st and 2nd year students in the five domains of medical informatics as defined by the AAMC. AD - Case Western Reserve University School of Medicine, Cleveland, OH, USA. FAU - Krause, Nicholas D AU - Krause ND FAU - Roulette, G Dante AU - Roulette GD FAU - Papp, Klara K AU - Papp KK FAU - Kaelber, David AU - Kaelber D LA - eng PT - Journal Article PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium JID - 101209213 SB - IM MH - *Computer Literacy MH - Data Collection MH - Education, Medical, Undergraduate MH - Medical Informatics/*education MH - Ohio MH - Professional Competence MH - Schools, Medical MH - *Students, Medical PMC - PMC1839636 OID - NLM: PMC1839636 EDAT- 2007/01/24 09:00 MHDA- 2007/09/29 09:00 CRDT- 2007/01/24 09:00 AID - 86056 [pii] PST - ppublish SO - AMIA Annu Symp Proc. 2006:989. PMID- 17238461 OWN - NLM STAT- MEDLINE DA - 20070122 DCOM- 20070928 LR - 20091119 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) DP - 2006 TI - Comparing perceptions and use of a commercial electronic medical record (EMR) between primary care and subspecialty physicians. PG - 841 AD - Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA. FAU - Allareddy, Veerajalandhar AU - Allareddy V FAU - Allareddy, Veerasathpurush AU - Allareddy V FAU - Kaelber, David C AU - Kaelber DC LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium JID - 101209213 SB - IM MH - Adult MH - *Attitude of Health Personnel MH - *Attitude to Computers MH - Data Collection MH - Humans MH - *Medical Records Systems, Computerized MH - Medicine MH - Middle Aged MH - Physicians, Family MH - Specialization PMC - PMC1839535 OID - NLM: PMC1839535 EDAT- 2007/01/24 09:00 MHDA- 2007/09/29 09:00 CRDT- 2007/01/24 09:00 AID - 86534 [pii] PST - ppublish SO - AMIA Annu Symp Proc. 2006:841. PMID- 16779289 OWN - NLM STAT- MEDLINE DA - 20060616 DCOM- 20070215 LR - 20090309 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) DP - 2005 TI - Evaluation of a commercial electronic medical record (EMR) by primary care physicians 5 years after implementation. PG - 1002 AB - Electronic medical records (EMRs) are gaining increasing prominence in the delivery of healthcare, although the focus is primarily on deploying EMRs. Relatively little research has studied the post-implementation of commercial EMRs. Here we present the results of a web-based survey of all the primary care clinicians in our university affiliated, tertiary care health system. The survey evaluated primary care clinician demographics, usage, and ideas for enhancement of the EpicCare EMR, five year after its initial deployment throughout our healthcare system. AD - Case Western Reserve University, MetroHealth Medical Center, Cleveland OH, USA. FAU - Kaelber, David AU - Kaelber D FAU - Greco, Peter AU - Greco P FAU - Cebul, Randall D AU - Cebul RD LA - eng PT - Evaluation Studies PT - Journal Article PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium JID - 101209213 SB - IM MH - Adult MH - Attitude of Health Personnel MH - *Attitude to Computers MH - Data Collection MH - Hospitals, University MH - Humans MH - Internal Medicine MH - *Medical Records Systems, Computerized MH - Medical Staff, Hospital MH - Pediatrics MH - Physicians, Family MH - *Primary Health Care PMC - PMC1560716 OID - NLM: PMC1560716 EDAT- 2006/06/17 09:00 MHDA- 2007/02/16 09:00 CRDT- 2006/06/17 09:00 AID - 58055 [pii] PST - ppublish SO - AMIA Annu Symp Proc. 2005:1002. PMID- 16639198 OWN - NLM STAT- MEDLINE DA - 20060426 DCOM- 20060613 LR - 20071115 IS - 1040-2446 (Print) IS - 1040-2446 (Linking) VI - 81 IP - 5 DP - 2006 May TI - Training experiences of U.S. combined internal medicine and pediatrics residents. PG - 440-6 AB - PURPOSE: To investigate the demographics and training experiences of internal medicine and pediatrics (med-peds) physicians. METHOD: A cross-sectional survey addressing demographics, training experiences, and career plans of fourth-year residents graduating from combined internal medicine and pediatrics programs that were identified in the American Academy of Pediatrics database was initiated in May 2003. Questionnaires were mailed up to four times to nonresponders through August 2003. RESULTS: Valid responses were received from 212 of the 340 graduating residents (62% response rate). The majority (186/208 [89%]) reported that they would choose med-peds training again. Career planning (135/210 [64%]), office management (173/212 [82%]), and outpatient procedures (155/211 [73%]) were the only areas where the majority desired more training. Neonatal intensive care training was the only topic area that the majority of residents (142/212 [67%]) reported could have been carried out in less time. Nearly all residents (183/196 [93%]) planned to care for children and adults. Residents' self-assessment of their preparation was good to excellent for evidence-based medicine (192/210 [91%]), caring for patients with special health care needs (179/209 [86%]), and use of information technology (169/208 [81%]). Residents felt equally well prepared for postgraduate activities in internal medicine and pediatrics primary care (170/212 [80%] versus 163/211 [77%], p = .305, NS) and internal medicine and pediatric fellowships (186/207 [90%] versus 181/208 [87%], p = .058, NS). Only 112 of 209 residents (54%) felt their preparation for research was good to excellent. CONCLUSIONS: The study findings suggest that med-peds residents are satisfied with their decision to train in med-peds and with their level of preparation. They feel equally well prepared to care for adults and children, and well prepared to care for patients that may transition to adulthood with complex needs, to assess evidence, and to use information technology. AD - Michigan State University/Kalamazoo Center for Medical Studies, Kalamazoo, Michigan, USA. FAU - Melgar, Thomas AU - Melgar T FAU - Chamberlain, John K AU - Chamberlain JK FAU - Cull, William L AU - Cull WL FAU - Kaelber, David C AU - Kaelber DC FAU - Kan, Brian D AU - Kan BD LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Acad Med JT - Academic medicine : journal of the Association of American Medical Colleges JID - 8904605 SB - AIM SB - IM MH - Academic Medical Centers/*organization & administration MH - Adult MH - *Attitude of Health Personnel MH - Career Choice MH - Cross-Sectional Studies MH - Data Collection MH - Databases as Topic MH - Female MH - Humans MH - Internal Medicine/*education MH - Internship and Residency/*organization & administration MH - Male MH - Pediatrics/*education MH - *Program Evaluation MH - Questionnaires MH - Time Factors MH - United States EDAT- 2006/04/28 09:00 MHDA- 2006/06/14 09:00 CRDT- 2006/04/28 09:00 AID - 10.1097/01.ACM.0000222276.83082.87 [doi] AID - 00001888-200605000-00007 [pii] PST - ppublish SO - Acad Med. 2006 May;81(5):440-6. PMID- 16291971 OWN - NLM STAT- MEDLINE DA - 20051118 DCOM- 20060302 LR - 20071115 IS - 0196-3635 (Print) IS - 0196-3635 (Linking) VI - 26 IP - 6 DP - 2005 Nov-Dec TI - Combination therapy: medicated urethral system for erection enhances sexual satisfaction in sildenafil citrate failure following nerve-sparing radical prostatectomy. PG - 757-60 AB - The objective of our study was to assess the effectiveness of combining medicated urethral system for erection (MUSE) with sildenafil citrate in men unsatisfied with the sildenafil alone. Baseline and follow-up data from 23 patients (mean age, 62.5 +/- 5.23 years) unsatisfied with the use of the sildenafil citrate alone for the treatment of erectile dysfunction following nerve-sparing radical prostatectomy (mean use, 4 attempts/100-mg dose) was obtained. All patients started oral sildenafil citrate more than 6 months after radical prostatectomy. Combination therapy was initiated using 100 mg sildenafil citrate orally 1 hour prior to intercourse. Patients used combination therapy for a minimum of 4 attempts prior to assessment with the Sexual Health Inventory of Men (International Index for Erectile Function-5) and visual analog scale to gauge rigidity (0-100). The effect of therapy on the total International Index for Erectile Function (IIEF) score and penile rigidity score was assessed. Of the 23 patients, 4 (17%) had no improvement with the addition of medicated urethral system for erection and discontinued the drug, while 19 (83%) reported improvement with the penile rigidity and sexual satisfaction. The IIEF scores of these 19 patients showed significant improvements in each sexual domain, and the patients reported that erection was sufficient for vaginal penetration 80% of the time. Rigidity scores on a scale of 0-100 with sildenafil alone averaged 38% (23-53) for men and 46% (26-67) for their partners. With the addition of MUSE, scores increased to 76% for men and 62% for their partners. We conclude that the addition of MUSE to sildenafil improved sexual satisfaction and penile rigidity in patients unsatisfied with sildenafil alone. AD - Center for Advanced Research in Human Reproduction, Infertility, and Sexual Function, Cleveland Clinic Foundation, OH 44105, USA. rraina@metrohealth.org FAU - Raina, Rupesh AU - Raina R FAU - Nandipati, Kalyana C AU - Nandipati KC FAU - Agarwal, Ashok AU - Agarwal A FAU - Mansour, David AU - Mansour D FAU - Kaelber, David C AU - Kaelber DC FAU - Zippe, Craig D AU - Zippe CD LA - eng PT - Journal Article PL - United States TA - J Androl JT - Journal of andrology JID - 8106453 RN - 0 (Piperazines) RN - 0 (Purines) RN - 0 (Sulfones) RN - 139755-83-2 (sildenafil) RN - 745-65-3 (Alprostadil) SB - IM MH - Alprostadil/administration & dosage/*therapeutic use MH - Drug Therapy, Combination MH - Erectile Dysfunction/*therapy MH - Humans MH - Male MH - Penile Erection/*drug effects MH - Piperazines/administration & dosage/*therapeutic use MH - Prostatectomy/*adverse effects MH - Prostatic Neoplasms/surgery MH - Purines MH - Sulfones MH - Urethra/*drug effects EDAT- 2005/11/18 09:00 MHDA- 2006/03/03 09:00 CRDT- 2005/11/18 09:00 AID - 26/6/757 [pii] AID - 10.2164/jandrol.05035 [doi] PST - ppublish SO - J Androl. 2005 Nov-Dec;26(6):757-60. PMID- 11346597 OWN - NLM STAT- MEDLINE DA - 20010510 DCOM- 20010531 LR - 20041117 IS - 1040-2446 (Print) IS - 1040-2446 (Linking) VI - 76 IP - 5 DP - 2001 May TI - A Web-based clinical curriculum on the cardiac exam. PG - 548-9 AD - Department of Internal Medicine, Metro Health Medical Center, Cleveland, OH 44109, USA. dck3@po.cwru.edu FAU - Kaelber, D C AU - Kaelber DC FAU - Bierer, S B AU - Bierer SB FAU - Carter, J R AU - Carter JR LA - eng PT - Evaluation Studies PT - Journal Article PL - United States TA - Acad Med JT - Academic medicine : journal of the Association of American Medical Colleges JID - 8904605 SB - AIM SB - IM MH - Attitude of Health Personnel MH - Cardiology/*education MH - Clinical Competence/*standards MH - Computer-Assisted Instruction/*methods MH - *Curriculum MH - Education, Medical, Undergraduate/*organization & administration MH - Heart Diseases/*diagnosis MH - Humans MH - Internet/*organization & administration MH - Ohio MH - Physical Examination/*methods MH - Program Evaluation MH - Students, Medical/psychology EDAT- 2001/05/11 10:00 MHDA- 2001/06/02 10:01 CRDT- 2001/05/11 10:00 PST - ppublish SO - Acad Med. 2001 May;76(5):548-9. PMID- 10355549 OWN - NLM STAT- MEDLINE DA - 19990715 DCOM- 19990715 LR - 20071114 IS - 0090-6964 (Print) IS - 0090-6964 (Linking) VI - 26 IP - 1 DP - 1998 Jan-Feb TI - A field-compatible method for interpolating biopotentials. PG - 37-47 AB - Mapping of bioelectric potentials over a given surface (e.g., the torso surface, the scalp) often requires interpolation of potentials into regions of missing data. Existing interpolation methods introduce significant errors when interpolating into large regions of high potential gradients, due mostly to their incompatibility with the properties of the three-dimensional (3D) potential field. In this paper, an interpolation method, inverse-forward (IF) interpolation, was developed to be consistent with Laplace's equation that governs the 3D field in the volume conductor bounded by the mapped surface. This method is evaluated in an experimental heart-torso preparation in the context of electrocardiographic body surface potential mapping. Results demonstrate that IF interpolation is able to recreate major potential features such as a potential minimum and high potential gradients within a large region of missing data. Other commonly used interpolation methods failed to reconstruct major potential features or preserve high potential gradients. An example of IF interpolation with patient data is provided to illustrate its applicability in the actual clinical setting. Application of IF interpolation in the context of noninvasive reconstruction of epicardial potentials (the "inverse problem") is also examined. AD - Cardiac Bioelectricity Research and Training Center, Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106-7207, USA. FAU - Burnes, J E AU - Burnes JE FAU - Kaelber, D C AU - Kaelber DC FAU - Taccardi, B AU - Taccardi B FAU - Lux, R L AU - Lux RL FAU - Ershler, P R AU - Ershler PR FAU - Rudy, Y AU - Rudy Y LA - eng GR - GM-07535/GM/NIGMS NIH HHS/United States GR - HL-33343/HL/NHLBI NIH HHS/United States GR - HL-49054/HL/NHLBI NIH HHS/United States GR - etc. PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PL - UNITED STATES TA - Ann Biomed Eng JT - Annals of biomedical engineering JID - 0361512 SB - IM MH - Action Potentials/physiology MH - Animals MH - Bias (Epidemiology) MH - Body Surface Potential Mapping/instrumentation/*methods MH - Child MH - Dogs MH - Humans MH - Male MH - *Numerical Analysis, Computer-Assisted/instrumentation MH - Reproducibility of Results MH - *Signal Processing, Computer-Assisted/instrumentation EDAT- 1999/06/04 MHDA- 1999/06/04 00:01 CRDT- 1999/06/04 00:00 PST - ppublish SO - Ann Biomed Eng. 1998 Jan-Feb;26(1):37-47.