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Biomedical subjects

Aaron E Carroll

Publications and source records attributed to Aaron E Carroll.

At least 19 recordsLinked to original sources
PubMed2007

A systematic review of school-based interventions to prevent bullying.

OBJECTIVE: To conduct a systematic review of rigorously evaluated school-based interventions to decrease bullying. DATA SOURCES: MEDLINE, PsycINFO, EMBASE, Educational Resources Information Center, Cochrane Collaboration, the Physical Education Index, and Sociology: A SAGE Full-Text Collection were searched for the terms bullying and bully. STUDY SELECTION: We found 2090 article citations and reviewed the references of relevant articles. Two reviewers critically evaluated 56 articles and found 26 studies that met the inclusion criteria. INTERVENTIONS: The types of interventions could be categorized as curriculum (10 studies), multidisciplinary or "whole-school" interventions (10 studies), social skills groups (4 studies), mentoring (1 study), and social worker support (1 study). MAIN OUTCOME MEASURES: Data were extracted regarding direct outcome measures of bullying (bullying, victimization, aggressive behavior, and school responses to violence) and outcomes indirectly related to bullying (school achievement, perceived school safety, self-esteem, and knowledge or attitudes toward bullying). RESULTS: Only 4 of the 10 curriculum studies showed decreased bullying, but 3 of those 4 also showed no improvement in some populations. Of the 10 studies evaluating the whole-school approach, 7 revealed decreased bullying, with younger children having fewer positive effects. Three of the social skills training studies showed no clear bullying reduction. The mentoring study found decreased bullying for mentored children. The study of increased school social workers found decreased bullying, truancy, theft, and drug use. CONCLUSIONS: Many school-based interventions directly reduce bullying, with better results for interventions that involve multiple disciplines. Curricular changes less often affect bullying behaviors. Outcomes indirectly related to bullying are not consistently improved by these interventions.

Aggression↗
PubMed2006

Systematic review of the relationship between early introduction of solid foods to infants and the development of allergic disease.

OBJECTIVE: To assess the evidence that early solid feeding (before age 4 months) increases the risk of allergic disease. DATA SOURCES: MEDLINE, the Cochrane Library, and the Drugs and Pharmacology section of EMBASE with key words "infant," "food," and "allergy." STUDY SELECTION: We found 2719 article citations and reviewed references of relevant articles. We critically evaluated the methods and results of articles that met inclusion criteria. We identified 13 studies that met inclusion criteria. There was only 1 controlled trial. DATA EXTRACTION: Allergic disease. DATA SYNTHESIS: Five studies found a positive association between early solid feeding and eczema, with a persistence of the association for 10 years in 1 study. Four studies found no association. One study found an association between early solid feeding and pollen allergy. We found no strong evidence to support the association between early solid feeding and the development of persistent asthma, persistent food allergy, allergic rhinitis, or animal dander allergy. CONCLUSIONS: Systematic review of available evidence suggests that early solid feeding may increase the risk of eczema. However, there are little data supporting an association between early solid feeding and other allergic conditions. Since many studies had problematic methods, additional controlled trials are needed to help guide physicians as they advise parents about the allergic risks of early introduction of solids.

Eczema↗
PubMed2006

Compliance with guidelines for ADHD: a pilot study of an evaluation tool.

The investigators developed a 1-page chart abstraction tool to evaluate compliance with practice guidelines for attention deficit hyperactivity disorder. The tool had strong inter-rater reliability, with kappa of 0.81. Pilot testing for 57 children with attention deficit hyperactivity disorder showed only 12% documented full compliance with assessment guidelines and 44% with treatment guidelines.

Adolescent↗
PubMed2006

How do parents perceive their adolescent's diabetes: a qualitative study.

BACKGROUND/AIMS: The developmental tasks of adolescence, combined with physical changes, can interfere with self-management behaviour. Yet little is known about how parents view these challenges as they attempt to help their children cope with diabetes. Our objective was to understand how living with an adolescent with diabetes influences parents' perceptions of their child's well-being, their relationship with their child, and how they perceive the influence of peers and school on their child's diabetes. METHODS: Twenty-eight parents of adolescents with Type 1 diabetes, aged 13-18 years, participated in focus groups. Transcripts were analysed using qualitative methods to determine dominant themes and incidence density. RESULTS: Themes included how diabetes negatively influences their adolescent's lifestyle, how diabetes makes it difficult for parents to understand developmental challenges experienced by their child, concerns regarding the potential to develop long-term complications, perceptions on how diabetes impacts on their relationship with their child and relationships with peers and how their children's school impacts on their diabetes self-management CONCLUSIONS: This qualitative focus group study provides insight into parental perceptions of adolescents living with Type 1 diabetes, specifically as it relates to lifestyle implications, relationships with parents, peers and physicians, and school experiences.

Adolescent↗
PubMed2006

Shortcomings in infant iron deficiency screening methods.

BACKGROUND: Screening for iron deficiency anemia is a well-established practice in pediatrics, but numerous challenges surrounding current recommendations raise questions about the effectiveness of this strategy. OBJECTIVE: To evaluate iron deficiency anemia screening approaches, by assessing rates of follow-up testing and resolution among patients meeting screening criteria in a primary care setting. METHODS: A retrospective cohort study was performed. We extracted electronic medical record data on complete blood counts for infants who received primary care in our clinics in the past 10 years. We calculated rates of positive screening results with 9 different measurement criteria and determined rates of follow-up testing and of documented correction of iron deficiency among those who screened positive. RESULTS: Our cohort consisted of 4984 children who were screened at 9 to 15 months of age, between 1994 and 2004. There was a wide distribution of positive detection rates (range: 1.5-14.5%) among the 9 screening criteria. Follow-up testing rates were low. No more than 25% of infants who screened positive by any criterion underwent a repeat complete blood count within 6 months. Moreover, no more than 11.6% (range: 4.4-11.6%) had documented correction of their laboratory abnormalities. CONCLUSIONS: Significant shortcomings exist in current iron deficiency anemia screening practices. A widely agreed-on, specific, and inexpensive screening criterion, with increased emphasis on systems-based approaches to iron deficiency screening, is needed.

Anemia, Iron-Deficiency↗
PubMed2006

Comprehensive cost-utility analysis of newborn screening strategies.

BACKGROUND: Inborn errors of metabolism are a significant cause of morbidity and death among children. Inconsistencies in how individual states arrive at screening strategies, however, lead to marked variations in testing between states. OBJECTIVE: To determine the cost-effectiveness of each component test of a multitest newborn screening program, including screening for phenylketonuria, congenital adrenal hyperplasia, congenital hypothyroidism, biotinidase deficiency, maple syrup urine disease, galactosemia, homocystinuria, and medium-chain acyl-CoA dehydrogenase deficiency. METHODS: A decision model was used, with cohort studies, government reports, secondary analyses, and other sources. Discounted costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were measured. RESULTS: All except 2 screening tests dominated the "no-test" strategy. The 2 exceptions were screening for congenital adrenal hyperplasia, which cost slightly more than $20,000 per QALY gained, and screening for galactosemia, which cost $94,000 per QALY gained. The screening test with the lowest expected cost was tandem mass spectrometry. The results found in our base-case analysis were stable across variations in nearly all variables. In instances in which changes in risks, sequelae, costs, or utilities did affect our results, the variation from base-case estimates was quite large. CONCLUSIONS: Newborn screening seems to be one of the rare health care interventions that is beneficial to patients and, in many cases, cost saving. Over the long term, funding comprehensive newborn screening programs is likely to save money for society.

Cost-Benefit Analysis↗
PubMed2005

Automating the recognition and prioritization of needed preventive services: early results from the CHICA system.

An ever-growing plethora of preventive services guidelines threatens to overwhelm primary care providers who are expected to recognize and prioritize these needed services for each patient. The Child Health Improvement through Computer Automation (CHICA) system was designed to facilitate this process through a workflow-sensitive interface that gathers and distills the most relevant patient data within pediatric settings. We evaluated family responses to 21 CHICA questions that assess risk factors and health behaviors over a three month period. 3005 patients provided 15,434 responses to these questions, and 1756 or 11.3% of these suggest risk factors which merit attention. This preliminary analysis suggests that, using CHICA, families identify significant risk factors that our clinicians acknowledge are often overlooked given the realities of practicing within this setting.

Adolescent↗
PubMed2005

Household computer and Internet access: The digital divide in a pediatric clinic population.

Past studies have noted a digital divide, or inequality in computer and Internet access related to socio-economic class. This study sought to measure how many households in a pediatric primary care outpatient clinic had household access to computers and the Internet, and whether this access differed by socio-economic status or other demographic information. We conducted a phone survey of a population-based sample of parents with children ages 0 to 11 years old. Analyses assessed predictors of having home access to a computer, the Internet, and high-speed Internet service. Overall, 88.9% of all households owned a personal computer, and 81.4% of all households had Internet access. Among households with Internet access, 48.3% had high speed Internet at home. There were significant associations between home computer ownership or Internet access and parental income or education. There was no relationship these factors and high speed Internet access. Over 60% of families with annual household income of $10,000-$25,000, and nearly 70% of families with only a high-school education had Internet access at home. While income and education remain significant predictors of household computer and internet access, many patients and families at all economic levels have access, and might benefit from health promotion interventions using these modalities.

Computers↗
PubMed2005

Human and system errors, using adaptive turnaround documents to capture data in a busy practice.

Capturing coded clinical data for clinical decision support can improve care, but cost and disruption of clinic workflow present barriers to implementation. Previous work has shown that tailored, scannable paper forms (adaptive turnaround documents, ATDs) can achieve the benefits of computer-based clinical decision support at low cost and minimal disruption of workflow. ATDs are highly accurate under controlled circumstances, but accuracy in the setting of busy clinics with untrained physician users is untested. We recently developed and implemented such a system and studied rates of errors attributable to physician users and errors in the system. Prompts were used in 63% of encounters. Errors resulting from incorrectly marking forms occurred in 1.8% of prompts. System errors occurred in 7.2% of prompts. Most system errors were failures to capture data and may represent human errors in the scanning process. ATDs are an effective way to collect coded data from physicians. Further automation of the scanning process may reduce system errors.

Ambulatory Care Information Systems↗
PubMed2004

Pediatricians' use of and attitudes about personal digital assistants.

BACKGROUND: Personal digital assistants (PDAs) are being increasingly used in medical practice. Although they have been touted as having the ability to improve efficiency and safety, little is known about pediatricians' use of and attitudes about PDAs. OBJECTIVE: Our goals were to 1) determine the percentage of pediatricians using PDAs and computers, 2) determine perceived strengths and weaknesses of PDAs, and 3) explore characteristics associated with beliefs and use. DESIGN/METHODS: Pediatricians (2130) were selected randomly from the American Medical Association Physician Masterfile of US-licensed physicians. All participants were mailed a survey along with a prepaid return envelope and a 1 dollar incentive. Up to 3 mailings were sent per participant. RESULTS: Of eligible participants, 63.2% returned a survey. There were no significant differences between respondents and nonrespondents with respect to sex, type of practice, and present employment. Thirty-five percent of respondents currently use PDAs at work, and 40% currently use PDAs for personal use. Of those using PDAs, the most commonly used applications were for drug reference (80%), personal scheduling (67%), and medical calculations (61%). Few pediatricians are currently using PDAs for prescription writing (8%) or billing (4%). Users of PDAs were more likely to be male (adjusted odds ratio [AOR]: 2.29; 95% confidence interval [CI]: 1.64-3.19), in an urban community (AOR: 1.81; 95% CI: 1.30-2.55), in training (AOR: 2.64; 95% CI: 1.58-4.42), not in private practice (AOR: 1.47; 95% CI: 1.03-2.11), and a more recent graduate of medical school (AOR: 1.04 per year; 95% CI: 1.02-1.06). When controlling for covariates, those using PDAs were more likely to believe that PDAs can decrease medical errors (AOR: 2.22; 95% CI: 1.46-3.38) and increase efficiency (AOR: 2.40; 95% CI: 1.56-3.71). When compared with nonusers, users were less likely to view the small screen size (AOR: 0.53; 95% CI: 0.37-0.77) or system speed (AOR: 0.47; 95% CI: 0.26-0.84) as a problem but were significantly more likely to view memory as an issue (AOR: 3.48; 95% CI: 2.30-5.25). CONCLUSIONS: More than one third of pediatricians are using PDAs in clinical practice. There seems to be a general consensus among users that they have the potential to improve patient safety and streamline care. Future studies should explore means to utilize their potential.

Age Factors↗
PubMed2004

The effect of point-of-care personal digital assistant use on resident documentation discrepancies.

BACKGROUND: We recently found documentation discrepancies in 60% of resident daily-progress notes with respect to patient weight, medications, or vascular lines. To what extent information systems can decrease such discrepancies is unknown. OBJECTIVE: To determine whether a point-of-care personal digital assistant (PDA)-based patient record and charting system could reduce the number of resident progress-note documentation discrepancies in a neonatal intensive care unit (NICU). DESIGN/METHODS: We conducted a before-and-after trial in an academic NICU. Our intervention was a PDA-based patient record and charting system used by all NICU resident physicians over the study period. We analyzed all resident daily-progress notes from 40 randomly selected days over 4 months in both the baseline and intervention periods. Using predefined reference standards, we determined the accuracy of recorded information for patient weights, medications, and vascular lines. Logistic and Poisson regression were used in analyses to control for potential confounding factors. RESULTS: A total of 339 progress notes in the baseline period and 432 progress notes in the intervention period were reviewed. When controlling for covariates in the regression, there were significantly fewer documentation discrepancies of patient weights in notes written by using the PDA system (14.4%-4.4% of notes; odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.15-0.56). When using the PDA system, there were no significant changes in the numbers of notes with documentation discrepancies of medications (27.7%-17.1% of notes; OR: 0.63; 95% CI: 0.35-1.13) or vascular lines (33.6%-36.1% of notes; OR: 1.11; 95% CI: 0.66-1.87). CONCLUSIONS: The use of our PDA-based point-of-care patient record and charting system showed a modest benefit in reducing the number of documentation discrepancies in resident daily-progress notes. Further study of PDAs in information systems is warranted before they are widely adopted.

Computers, Handheld↗
PubMed2003

Support for national health insurance among U.S. physicians: a national survey.

BACKGROUND: Nearly 40 million persons in the United States were without health insurance for all of 2000. National health insurance would remedy this situation, and many believe the success of reform efforts in this direction may depend on physician support. OBJECTIVE: To determine the general attitudes of U.S. physicians toward the financing of national health care. DESIGN: Cross-sectional study. SETTING: National mailed survey. PARTICIPANTS: 3188 randomly sampled physicians from the American Medical Association Physician Masterfile. MEASUREMENTS: Physicians were asked whether they support or oppose 1) governmental legislation to establish national health insurance and 2) a national health insurance plan in which all health care is paid for by the federal government. Weighted multivariate logistic regression analyses were performed to identify factors that independently predicted support for each of these strategies. RESULTS: Sixty percent of eligible participants returned a survey. Forty-nine percent of physicians supported governmental legislation to establish national health insurance, and 40% opposed it. Only 26% of all physicians supported a national health insurance plan in which all health care is paid for by the federal government. In analyses adjusting for differences in personal and practice characteristics, physicians in a primary care specialty, physicians reporting that at least 20% of their patients had Medicaid, and physicians practicing in a nonprivate setting or in an inner-city location were statistically significantly more likely to support governmental legislation to establish national health insurance. CONCLUSIONS: A plurality of U.S. physicians supports governmental legislation to establish national health insurance. This support may be relevant to the success of future efforts to reform national health care.

Attitude of Health Personnel↗
PubMed2003

Resident documentation discrepancies in a neonatal intensive care unit.

CONTEXT: Medical errors are common and potentially dangerous. Little is known about the role of documentation errors. OBJECTIVE: To determine the proportion of resident physician progress notes that contained discrepancies, and to identify predictors of such discrepancies. DESIGN/METHODS: We conducted a retrospective cross-sectional chart review of resident physician progress notes over 40 random days in a 4-month period in a neonatal intensive care unit. Using predetermined criteria, we compared resident documentation of patient weights, medications, and vascular lines to other sources of information and recorded the numbers of documentation discrepancies. RESULTS: There were discrepancies in 209 (61.7%) notes with respect to weight, vascular lines, or medications. Discrepancies occurred in the documentation of medications in 103 (27.7%) progress notes, of vascular lines in 119 (33.9%) progress notes, and of weights in 45 (13.3%) progress notes. Notes both omitted information regarding medications (18.2%) and vascular lines (13.9%) and documented inaccurate information regarding medications (18.6%) and vascular lines (30.1%). Patients with more medications or vascular lines, and with longer lengths of stay, were significantly more likely to have higher rates of documentation errors. CONCLUSIONS: Daily progress notes written by resident physicians in the neonatal intensive care unit often contain inaccurate, or omit pertinent, information. Alternative means or methods of documentation are warranted.

Birth Weight↗
PubMed2003

Does presentation format at the Pediatric Academic Societies' annual meeting predict subsequent publication?

OBJECTIVE: The validity of research presented at scientific meetings continues to be a concern. Presentations are chosen on the basis of submitted abstracts, which may not contain sufficient information to assess the validity of the research. The objective of this study was to determine 1) the proportion of abstracts presented at the annual Pediatric Academic Society (PAS) meeting that were ultimately published in peer reviewed journals; 2) whether the presentation format of abstracts at the meeting predicts subsequent full publication; and whether the presentation format was related to 3) the time to full publication or 4) the impact factor of the journal in which research is subsequently published. METHODS: We assembled a list of all abstracts submitted to the PAS meetings in general pediatrics categories in 1998 and 1999, using both CD-ROM and journal publications. In each year, we chose up to 80 abstracts from each presentation format ("publish only," "poster," "poster symposium," "platform presentation"). We chose either 1) all abstracts in each format or 2) when there were >80 abstracts, a random selection of 80 of them. We assessed each selected abstract for subsequent full publication by searching Medline in March 2003; if published, then we recorded the journal, month, and year of publication. We used logistic and linear regression to determine whether publication, time to publication, and the journal's impact factor were associated with the abstract's presentation format. RESULTS: Overall, 44.6% of abstracts presented at the PAS meeting achieved subsequent full publication within 4 to 5 years. There were significant differences between the rates of subsequent full publication of abstracts submitted but not chosen for presentation at the meeting (22.2%) and those that were chosen for presentation in poster sessions (40.0%), poster symposia (44.1%), and platform presentations (53.8%). There were no meaningful differences between the presentation formats in their mean time to publication and their mean journal impact factor. CONCLUSIONS: PAS meeting attendees and the press should be cautious when interpreting the presentation format of an abstract as a predictor of either its subsequent publication in a peer-reviewed journal or the impact factor of the journal in which it will appear.

Abstracting and Indexing↗
PubMed2003

Pediatricians and personal digital assistants: what type are they using?

Increasing attention is being focused on the potential benefits of personal digital assistants (PDA) in medical practice. Although some work has been done to investigate their use, it is still unclear what types of PDAs are being used by pediatricians, and if they are using different types in different ways. Our goals were to determine: (1) which kinds of PDAs were being used by pediatricians; (2) if the personal or professional characteristics of pediatricians differ by type of PDA they are using; (3) if the types of applications they employ differ by the type of PDAs they are using. We randomly selected 2130 pediatricians from the AMA masterfile of United States licensed physicians and surveyed them. Of those respondents that reported using a PDA, 89.7% use a Palm OS based system, 8.9% use a Pocket PC based system, and 1.4% used neither. Residents were significantly more likely to use a Palm OS based PDA than non residents (OR 6.32, 95%CI 1.41-27.53). There were significant associations between the PDA platform being used and types of applications being run on them. More than one third of pediatricians are using PDAs in clinical practice. Palm OS based systems are much more prevalent in clinical practice, and the choice of newer pediatricians.

Computers, Handheld↗
PubMed2002

A systematic review of nonpharmacological and nonsurgical therapies for gastroesophageal reflux in infants.

BACKGROUND: Nonpharmacological and nonsurgical measures are often recommended for gastroesophageal reflux disease (GERD) in infants, despite ambiguous supporting evidence. OBJECTIVE: To conduct a systematic review of rigorously evaluated nonpharmacological and nonsurgical therapies for GERD in infants. DESIGN/METHODS: We searched online bibliographic databases, including MEDLINE, EMBASE, the Cochrane Collaboration and Clinical Trials Database, and alternative medicine databases for the terms gastroesophageal reflux and infants. We selected randomized controlled trials of nonpharmacological and nonsurgical GERD therapies in otherwise healthy infants. Data were extracted from the selected articles regarding reflux, emetic episodes and intraesophageal pH. RESULTS: We identified 43 relevant studies, of which 10 met the selection criteria. These studies examined positioning, pacifier use, and feeding changes. Positioning at a 60 degree elevation in an infant seat was found to increase reflux compared with the prone position. No significant difference was shown between the flat and head-elevated prone positions. The impact of pacifier use on reflux frequency was equivocal and dependent on infant position. The protein content of formula was not found to affect reflux. Although no study demonstrated a significant reflux-reducing benefit of thickened infant foods compared with placebo, 1 study detected a significant benefit of formula thickened with carob bean gum compared with rice flour (pH<4 for 5% vs 8% of time). Another study showed that if supplementing with dextrose 5% water or dextrose 10% water, the lower-osmolality fluid was associated with less reflux. CONCLUSIONS: Many conservative measures commonly used to treat GERD in infants have no proven efficacy. Although thickened formulas do not appear to reduce measurable reflux, they may reduce vomiting. Further studies with clinical outcomes are needed to answer questions about efficacy definitively.

Gastroesophageal Reflux↗
PubMed2002

A comparison of a lecture and computer program to teach fundamentals of the Draw-a-Person test.

BACKGROUND: Although computer-assisted education has been used to augment education in many areas, there are few studies of programs designed to replace lectures in a medical curriculum. OBJECTIVE: To test whether a thoughtfully designed computer program can replace a standard lecture in a pediatrics curriculum while teaching the subject matter equally well. METHODS: A computer program was developed to teach the Draw-a-Person developmental test using the multimedia-authoring tool Director. One of us (A.E.C.) tested and modified the program several times during its creation after submitting it to several objective evaluators. Thirty-nine students taking the clinical pediatrics rotation were chosen by month to interact with the program or attend the lecture. All students then scored 3 drawings and assigned them a developmental age according to the Draw-a-Person test rules. Students assigned to the computer program also completed a questionnaire evaluating the program in several subjective areas. A t test for 2 samples assuming equal variance was used to analyze the test results. RESULTS: Students receiving the lecture (control group) scored the 3 drawings as 5.43 years (age range, 4.5-8 years), 9.08 years (age range, 7-12 years), and 3.5 years (age range, 2-5 years), respectively. Those using the computer program (study group) scored the 3 drawings as 5.91 years (age range, 5-7 years), 7.68 years (age range, 7-8 years), and 4.34 years (age range, 3-5 years), respectively. The correct answers for the ages were 6, 7.75, and 4.25 years, respectively. A t test for 2 samples assuming equal variance showed that students using the computer program performed better on all 3 drawings (P<.05, P<.02, and P<.002, respectively). CONCLUSIONS: Students using the computer program were more accurate than students attending the lecture when scoring drawings and estimating a developmental age from them. These results support the conclusion that a thoughtfully designed computer program can replace a standard lecture in a pediatrics curriculum.

Attitude to Computers↗