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Biomedical subjects

Christoph U Lehmann

Publications and source records attributed to Christoph U Lehmann.

At least 19 recordsLinked to original sources
PubMed2006

Detection and management of pornography-seeking in an online clinical dermatology atlas.

BACKGROUND: Increased use of an online educational archive of photographic dermatology case materials (DermAtlas) indicated unexpected pornography-seeking behavior and misuse. OBJECTIVE: We sought to assess the extent of archive misuse. METHODS: Web usage/request patterns were examined over a 6-month period for requests by anatomic site, diagnosis, and age group plus anatomic site. Free-text queries and referrals from external Web sites were reviewed. RESULTS: Of 7800 images, 5.5% contain genital sites. Of all requests, 11% were for anatomic sites (37% genital sites); 62% were specified for diagnoses (12% genital sites). When age group and anatomic site were specified, the relative risk of a child being requested (vs adult) was 1.48 (95% confidence interval 1.44-1.53). Of 10000 free text queries, 12% retrieved images containing genital sites. Of all referrals, 14.3% originated from nonmedical (pornography/fetish) Web sites. LIMITATIONS: Requests are mixed with legitimate queries. CONCLUSION: Online photographic dermatology archives are vulnerable to misuse. Monitoring and intervention are necessary to preserve their availability and integrity.

Dermatology↗
PubMed2006

Error reduction in pediatric chemotherapy: computerized order entry and failure modes and effects analysis.

OBJECTIVE: To implement and evaluate the impact of computerized provider order entry (CPOE) on reducing ordering errors in pediatric chemotherapy. DESIGN: Before-and-after study from 2001 to 2004. SETTING: Pediatric Oncology in an academic medical center. INTERVENTION: Implementation of a CPOE system guided by multidisciplinary failure modes and effects analysis into pediatric chemotherapy. MAIN OUTCOME MEASURES: Completion data on chemotherapy steps of high morbidity/mortality potential if missed (as determined by attending oncologists) from 1259 pre-CPOE paper and 1116 post-CPOE pediatric chemotherapy orders. RESULTS: After CPOE deployment, daily chemotherapy orders were less likely to have improper dosing (relative risk [RR], 0.26; 95% confidence interval [CI], 0.11-0.61), incorrect dosing calculations (RR, 0.09; 95% CI, 0.03-0.34), missing cumulative dose calculations (RR, 0.32; 95% CI, 0.14-0.77), and incomplete nursing checklists (RR, 0.51; 95% CI, 0.33-0.80). There was no difference in the likelihood of improper dosing on treatment plans and a higher likelihood of not matching medication orders to treatment plans (RR, 5.4; 95% CI, 3.1-9.5). CONCLUSION: Failure modes and effects analysis-guided CPOE reduced ordering errors in pediatric chemotherapy and provided data for further improvements.

Academic Medical Centers↗
PubMed2006

Computerized provider order entry and patient safety.

Computerized provider order entry (CPOE) and clinical decision support (CDS) are advocated health care information technologies for improving patient safety through reduction and prevention of medication errors. CPOE and DCS target specific errors in medication processes, particularly in prescribing and ordering. These are of particular importance in pediatrics, because children may be more vulnerable to prescribing errors than adults. Studies of CPOE/CDS performed at academic medical centers have demonstrated their effectiveness in reducing medication process errors in pediatrics, but scant data so far show effects on health outcomes. CPOE/CDS adoption requires significant expertise in health care processes, information technology, and change management. Adoption is a high-cost, high-risk venture with political implications.

Child↗
PubMed2006

Neonatal nucleated red blood cells and the prediction of cerebral white matter injury in preterm infants.

OBJECTIVE: To estimate whether neonates with cerebral white matter injury have significant elevations in nucleated red blood cell counts and to estimate their predictive ability in identifying injury. METHODS: This case-control study identified 176 infants born at 23-34 weeks of gestation between November 1994 and October 2004 at a single university hospital and with cerebral white matter injury characterized by periventricular leukomalacia (PVL) or ventriculomegaly due to white matter atrophy. A control was matched to each case using the subsequent delivery within 7 days of that gestational age without brain injury. RESULTS: The gestational age at birth was 27 weeks for both groups, but the cases had a significantly lower birth weight (mean +/- standard deviation: 958 +/- 306 g compared with 1,038 +/- 381 g, P = .001). There was no difference in cesarean delivery (48% cases compared with 44% controls, P = .59). The cases had a significant increase in nucleated red blood cells per 100 white blood cells (WBC) (median, 5th percentile and 95th percentile: 22, 3 and 374 cases compared with 14, 1 and 312 controls; P = .02). Markers of chronic hypoxia, such as intrauterine growth restriction and oligohydramnios, and markers of acute hypoxia, such as an umbilical arterial pH less than 7.0 or base excess less than -12 mM, were both associated with significantly elevated neonatal nucleated red blood cell counts. A neonatal nucleated red blood cell count of 18 per 100 WBCs had a sensitivity of 56.9%, specificity of 57.9%, positive predictive value of 57.9%, and negative predictive value of 56.9% in predicting the development of cerebral white matter injury in this matched case-control sample. CONCLUSION: Preterm neonates with cerebral white matter injury have significant increases in nucleated red blood cell counts. Both acute and chronic hypoxia-ischemia can increase these counts, which limits their usefulness in timing injury. The predictive value of nucleated red blood cell counts at birth in identifying injury is poor. LEVEL OF EVIDENCE: II-2.

Biomarkers↗
PubMed2006

Decreasing errors in pediatric continuous intravenous infusions.

OBJECTIVE: To evaluate the effect of a Web-based calculator and decision-support system on infusion ordering errors and to estimate error frequency in pharmacy infusion preparation. DESIGN: Data on ordering error frequency and typology were collected before and after implementation of an online infusion ordering system. Data on pharmacy preparation errors of infusions were collected. SETTING: A children's hospital at an academic medical center. PATIENTS: None. Data were abstracted from infusion orders. INTERVENTIONS: Introduction of a voluntary-use Web-based calculator into infusion ordering workflow. Observation only. MAIN OUTCOME MEASURES: Number and type of errors in handwritten and calculator-generated orders. Number and type of errors in pharmacy infusion preparation. RESULTS: Before calculator deployment, 129 sequential handwritten infusion orders were collected over 5 weeks. After deployment, of 162 sequential infusion orders, 88% (142) were calculator-generated. Calculator-generated infusion orders contained 83% fewer (p < .001) orders containing one or more errors than handwritten orders. Calculator-generated orders contained no high-risk errors (incorrect decimal, dose, or unit of measure) when compared with handwritten orders and were associated with fewer pharmacy interventions. In 118 sequential pharmacy infusion preparations over 4 wks, there were no errors observed. CONCLUSION: A Web-based calculator reduced significantly the total number of errors and eliminated all high-risk errors in the prescribing process for continuous pediatric infusions. With no observed errors in pharmacy preparation, this study provides data to support the use of computerized ordering as an independent safe and viable method for ordering continuous pediatric infusions.

Chi-Square Distribution↗
PubMed2006

Patient safety: a tale of two institutions.

The Johns Hopkins Medical Institutions and the University of Pittsburgh Medical Center are both working to improve patient safety. Johns Hopkins is focused on creating a culture of safety--frontline interventions at its Children's Center include a focus on the "Culture of Safety" and three programs that use information technology to "fix the broken medication process." Quantitative data indicate these programs are making care safer. At UPMC, efforts launched under the Robert Wood Johnson Foundation and the Institute of Health Care Improvement, a program named Transforming Care at the Bedside, are redesigning care processes to support nurses and focus on patients. Interventions include family-initiated rapid response teams and other changes designed to streamline processes and use information technology to make care patient-centered. Simulation-based training targets critical procedures and performance for physicians and nurses, and a "smart room" is slated for development.

Baltimore↗
PubMed2005

Prevention of medication errors.

Medication error is the most frequent source of medical error that is associated with adverse events, and, in many cases, is preventable. Medication errors can occur at any step in the medication process. Medication error prevention and reduction begins with a systematic approach to their detection. An important approach to mitigating errors involves the reduction of variation in task performance using tested techniques and technologies from other industries. The most important component of error prevention and reduction is the proactive promotion of a safety culture by organizational leadership, with sustained education and support for users.

Humans↗
PubMed2005

Heat loss prevention in the delivery room for preterm infants: a national survey of newborn intensive care units.

BACKGROUND: Hypothermia incurred during delivery room resuscitation continues to cause morbidity in infants <29 weeks gestation. Three recent trials have shown that wrapping such infants instead of drying prevents heat loss, resulting in higher infant temperatures at Newborn Intensive Care Unit (NICU) admission. OBJECTIVE: To describe current NICU practices with respect to wrapping preterm infants to prevent heat loss in the delivery room. STUDY DESIGN: E-mail survey of neonatologists from national registry using a web-based survey tool. RESULTS: Of 411 e-mails successfully delivered, 125 (30%) responded. Most (87%) represented level III NICUs. Almost one-fifth of respondents (20%) use occlusive material instead of drying preterms in the delivery room. Considerable variation exists regarding choice of wrap and duration of use. Few adverse events were reported. CONCLUSION: "In all" was added -This implies 20% of all NICU's changed practice, 20% of level III NICUs responding have changed delivery room resuscitation practices rapidly in response to new evidence. No "gold" standard exists nationally and there is considerable variation in practice. Neonatal resuscitation guidelines for premature infants should include recommendations regarding choice occlusive wrap and application techniques.

Delivery Rooms↗
PubMed2005

Diagnosis and management of vein of galen aneurysmal malformations.

Vein of Galen aneurysmal malformations (VGAM) are rare intracranial vascular anomalies typically found in children. The anatomic landmark of a VGAM is the presence of multiple arteriovenous shunts draining into a dilated median prosencephalic vein, an embryonic vessel normally absent at the adult stage. This article reviews the developmental anatomy, the clinical presentation, and the current management of VGAM.

Bioethical Issues↗
PubMed2005

Blocking of pornography-seeking behavior in digital image libraries: adventures in the skin trade.

The escalating competition between online pornography - seeking and disseminating behaviors and technologies that attempt to reduce them creates technical, semantic and legal barriers to the legitimate discussion of and education about sensitive health issues involving sexuality, anatomy and pathology, especially when image-based knowledge is used. The effects of this competition on the use and management of an online dermatology atlas are described with a discussion on the importance of anticipating, addressing and controlling this problem while developing and maintaining image-based digital libraries and other e-Health applications.

Adult↗
PubMed2005

Workflow and problem domain as information planning tools in a pediatric clinic--defining present and future information technology needs.

In 2002, $22.4 billion were spent on hospital construction in the US. With lifetimes for new buildings expected to be decades, planning a building's information technology infrastructure must take into account present and future needs. Workflow measurement and the definition of problem domain have been advanced as essential tools in addressing current requirements while anticipating future needs. To examine these, stakeholders must be identified-including both those who will use the facility and those who will be involved in the IT planning and long term support.

Child↗
PubMed2004

Preventing provider errors: online total parenteral nutrition calculator.

OBJECTIVE: To describe the development of a pragmatic low-cost medical information system that reduces errors in the ordering of total parenteral nutrition (TPN) in the newborn intensive care unit at the Johns Hopkins Hospital. METHODS: We designed an online total parenteral nutrition order entry system (TPNCalculator) using Internet technologies. Utilization, impact on medical errors, and user satisfaction were evaluated prior to and immediately after introduction of TPNCalculator (intervention 1) and after 2 years (intervention 2). RESULTS: Total software development time was 3 weeks. The number of orders was similar during the 3 periods: 0.39 orders per patient per day (N = 557) were received compared with 0.35 and 0.43 orders per patient per day (N = 471 and N = 656) in 2 intervention periods. During the control period, an average of 10.8 errors were detected per 100 TPN orders compared with 4.2 per 100 orders in the first intervention period (61% reduction of error rate) and 1.2 per 100 orders after 2 years and some redesign of TPNCalculator (89% reduction of error rate). We found a reduction in the following types of problems (intervention 1; intervention 2): calculation errors (100%; 100%), osmolality outside the allowed range (88%; 91%), and other knowledge problems (84%; 100%). There was a 35% increase in the number of incomplete forms in the first intervention period and a 100% reduction in the second. Rapid cycle development was used in the development of this application. Users of the system were enthusiastic and supportive and compared it favorably to the previous paper-based system. CONCLUSION: Low-cost, pragmatic approaches using Internet technology in the design of medical information systems can reduce medical errors and might pose a viable option for the prevention of adverse drug events.

Baltimore↗
PubMed2003

The impact of the Internet on pediatric medicine.

The Internet has affected pediatricians and the families they serve in many ways by empowering users to manage information, and to communicate faster and more effectively. The Internet allows practitioners to store, retrieve, and manipulate patient-specific and general medical information within increasingly sophisticated integrated systems, allowing 'just-in-time' information at the point of care. Related technologies allow asynchronous, real-time, and mobile communication with colleagues, patients, and health organizations. These same technologies have empowered patients to seek health information independently from online libraries, support groups, and second opinions not previously available, creating knowledgeable and value-conscious healthcare consumers, thus evolving the nature of the physician-patient relationship. Because of these technology advances and their present and future effects on practice and patients, it is increasingly important for the general pediatrician to be aware of the potentials, practicalities, and pitfalls of the Internet with regard to general pediatrics.

Access to Information↗
PubMed2002

Provider error prevention: online total parenteral nutrition calculator.

OBJECTIVE: 1. To reduce errors in the ordering of total parenteral nutrition (TPN) in the Newborn Intensive Care Unit (NICU) at the Johns Hopkins Hospital (JHH). 2. To develop a pragmatic low-cost medical information system to achieve this goal. METHODS: We designed an online total parenteral nutrition order entry system (TPNCalculator) using Internet technologies. Total development time was three weeks. Utilization, impact on medical errors and user satisfaction were evaluated. RESULTS: During the control period, 0.39 orders per patient per day (N=557) were received compared to 0.35 orders per patient per day (N=471) in the intervention period (NS). There was no significant difference in the percentage of late (incomplete by order deadline) TPN orders. During the control period, an average of 10.8 errors were detected per 100 TPN orders compared to 4.2 per 100 orders in the intervention period (61% reduction of error rate; p < 0.01). We found a reduction in the following types of problems: Calculation errors (100%), osmolality issues (87%) and other knowledge problems (84%). There was a 35% increase in the number of incomplete forms. Users of the system were enthusiastic and supportive and compared it favorably to the prior paper based system. CONCLUSION: Low-cost, pragmatic approaches utilizing Internet technology in the design of medical information systems can reduce medical errors and might pose a viable option for the prevention of adverse drug events.

Computer Systems↗
PubMedDate not supplied

Hyperglycemia and retinopathy of prematurity in very low birth weight infants.

OBJECTIVE: Retinopathy of prematurity (ROP) remains a leading cause of morbidity in the very low-birth-weight (VLBW) infant. This study investigates a possible association between serum/blood glucose and the development of ROP. METHODS: A retrospective case-control study of all infants born between 1992 and 1997 at the Johns Hopkins Hospital with birth weights less than 1000 g who developed Stage 3 or 4 ROP was conducted. Controls either had Stage 1 ROP or no eye disease and were matched 2:1 with ROP patients for gestational age, birth weight and year of birth. Odds ratios (ORs) of ROP were calculated for multiple exposures over the first month after birth, including oxygen concentration (FiO(2)), blood glucose levels, vitamin E, mean airway pressure and mean blood pressure. RESULTS: In a simple logistic regression analysis, we found an increased ROP risk for: (1) each 10 mg/dl increase of mean glucose (OR 1.96; 95% CI 1.13 to 3.42), (2) each 1% increase of mean FiO(2) (OR 1.06; 95% CI 1.004 to 1.13), (3) history of dopamine infusion (OR 5.4; 95% CI 1.16 to 25.2) and (4) intraventricular hemorrhage Grade 3 or 4 (OR 7.3; 95% CI 1.53 to 34.7). Using a multiple regression model, we found an increased ROP risk for each 10 mg/dl increase of mean glucose (OR 2.7; 95% CI 1.003 to 7.27). Each IU/kg/day of vitamin E supplementation reduced ROP risk (OR 0.37; 95% CI 0.16-0.86). CONCLUSION: In this study, we could demonstrate that glucose levels in the first month of life are associated with the development of ROP. Further studies have to determine if this association is causal or if hyperglycemia is just an expression of severity of illness.

Case-Control Studies↗