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Biomedical subjects

Mary Cooper

Publications and source records attributed to Mary Cooper.

9 recordsLinked to original sources
PubMed2007

To what extent do pediatricians accept computer-based dosing suggestions?

OBJECTIVE: Pediatric medication errors occur frequently among hospitalized patients and are often related to dosing. Computerized physician order entry systems with decision support can decrease dosing errors, as well as other types of errors; however, their use in pediatrics has not been extensively studied. Our objective was to determine physician acceptance of dosing and frequency decision support elements in an inpatient pediatric computerized physician order entry system at 1 academic medical center. PATIENTS AND METHODS: We performed a retrospective analysis of all electronic medication orders entered for pediatric inpatients at a large, urban teaching hospital between April 15, 2004, and December 31, 2004. Rates of physician acceptance of computerized physician order entry system-generated dosing and frequency suggestions were determined. RESULTS: We analyzed 54,413 orders in the computerized physician order entry system, of which 27,313 orders had dosing or frequency decision support. Of the orders with decision support, approximately one third (8822) were accepted exactly by prescribers. Of the 18,491 remaining orders, 8708 were changed for dose, 2466 for frequency, and 7317 for both. Among the 18,491 orders that were changed, the majority 11,322 deviated by a substantial amount (>50%) from the total daily dose initially suggested by the decision support feature. Overall, patient weight was missing 31.3% of the time, although patient age alone sometimes was sufficient for the computer to make a dosing suggestion. CONCLUSIONS: Although dosing-decision support systems have the potential to improve care, more work needs to be done to determine and optimize their effectiveness. Commercial vendors of dosing knowledge bases need to deliver effective products, because most health care organizations will not have the resources to customize decision support rules.

Adolescent↗
PubMed2006

Lack of adherence with preoperative B-blocker recommendations in a multicenter study.

BACKGROUND: Clinical guidelines support the use of preoperative B-blocker in select patients. Patient safety groups have sought to measure the level of adherence to these recommendations. OBJECTIVE: This study was performed to compare the utilization of preoperative B-blocker with current guidelines across multiple diverse institutions. DESIGN: Retrospective chart review was performed of inpatients undergoing noncardiac surgery across 5 hospital centers during 2003 to 2004. The primary outcome of interest was the administration of preoperative B-blocker. PARTICIPANTS: The study sample included 1,304 randomly selected patients meeting the guideline criteria for preoperative B-blockade. MEASUREMENTS AND MAIN RESULTS: Among patients meeting recommendations for preoperative B-blocker, only 44% (430/983) received B-blocker before surgery. Patients who had not previously received B-blocker were given B-blocker before surgery in only 14% (85/600) of cases. Target heart rates goals for perioperative B-blockade were achieved in 26% (113/430) of cases. Predictors for initiating preoperative B-blocker included nonelective surgery or a history of hypertension or diabetes. Individual hospitals were independently predictive of preoperative B-blocker administration in multivariable models. CONCLUSIONS: Preoperative B-blocker was significantly underutilized when compared with the current guideline recommendations. Target heart rate goals were not achieved in clinical practice, and few hospitalized patients had preoperative B-blockade initiated. The lack of adherence to preoperative B-blocker recommendations in practice may be impacted by ongoing clinical questions regarding the appropriate selection of candidates for this therapy. Further efforts toward achieving guideline recommendations for preoperative B-blocker use should be focused on the subset of patients that are uniformly agreed upon to be at high risk for cardiac events.

Adrenergic beta-Antagonists↗
PubMed2005

Laying foundations for health: food provision for under 5s in day care.

This study investigated the food offered to children under 5 years of age in UK day care, the influence of the childcare providers on a child's diet and their attitudes towards this role. A postal survey of a randomised quota sample of childcare providers enquired after the range of food on offer and explored attitudes towards the role of food in health and the role of promoting health. Themes emerging from these data were explored by in-depth interviews with a sample of 18 childcare providers and 7 Local Authority Early Years Service staff. We received 194 (56%) responses to 345 copies of the questionnaire. Half (46%) of nurseries and 23% of childminders provided a fruit or vegetable with the main meal 5 days a week. Only 14% of nurseries and 21% of childminders provided a dairy food (i.e. calcium-rich) at the main meal every day. Almost all the childcare providers saw themselves as responsible for promoting healthy diet, but it was rare for them to have had any formal training in nutrition, while current dietary guidance was perceived as too vague to be useful. The study also highlighted tensions on the issue of food provision between those delivering childcare and parents; further research should explore the parents' perspectives. Nursery staff and childminders should have access to carefully designed advice on nutritionally appropriate food and drink services for under-fives.

Attitude↗
PubMed2005

Long-term use of oral beclomethasone dipropionate for the treatment of gastrointestinal graft-versus-host disease.

Treatment of severe acute and chronic gastrointestinal (GI) graft-versus-host disease (GVHD) with prolonged high-dose systemic corticosteroids has limited success and considerable toxicity. Beclomethasone dipropionate (BDP) is a potent topically active steroid. We treated 15 patients with acute (n = 2) or chronic (n = 13) GI GVHD refractory to systemic corticosteroids with 28-day courses of oral BDP (2 mg 4 times daily). Response was measured by the change in GI score (sum of 6 GI symptoms) as well as the ability to taper or discontinue systemic corticosteroids. Nine (60%) of 15 evaluable patients responded to BDP, including 3 complete responses (a GI score of 0 or 1 and discontinuation of systemic corticosteroids). Attempts to taper calcineurin inhibitor during BDP therapy were unsuccessful. The 2 patients with acute GVHD had no response to BDP. Responders received a median of 3 cycles (range, 1-20), compared with 1 cycle (range, 1-5) in nonresponders. Suppression of the hypothalamic-adrenal axis was seen in 2 of the 5 patients tested, but neither demonstrated clinically significant symptoms. We conclude that BDP is safe and effective for long-term treatment of chronic GI GVHD. Multiple courses may be necessary to achieve or maintain response in some patients, and prolonged BDP therapy is a feasible alternative to prolonged systemic corticosteroids.

Administration, Oral↗
PubMed2005

Managing the alert process at NewYork-Presbyterian Hospital.

Clinical decision support can improve the quality of care, but requires substantial knowledge management activities. At NewYork-Presbyterian Hospital in New York City, we have implemented a formal alert management process whereby only hospital committees and departments can request alerts. An explicit requestor, who will help resolve the details of the alert logic and the alert message must be identified. Alerts must be requested in writing using a structured alert request form. Alert requests are reviewed by the Alert Committee and then forwarded to the Information Systems department for a software development estimate. The model required that clinical committees and departments become more actively involved in the development of alerts than had previously been necessary. In the 12 months following implementation, 10 alert requests were received. The model has been well received. A lot of the knowledge engineering work has been distributed and burden has been removed from scarce medical informatics resources.

Decision Support Systems, Clinical↗
PubMed2005

Electronic discharge summaries.

Timely completion of Discharge Summaries is a requirement of high quality care. We developed a system for writing electronic Discharge Summaries. DSUM Writer has generated 2464 of 7349 total summaries (34%) and has paid for itself during its first 8 weeks in production. DSUM Writer is a component of a suite of tools (eNote) for electronic physician documentation used to support clinical care, billing and narrative analysis research.

Cost Savings↗
PubMed2003

A handheld real time thermal cycler for bacterial pathogen detection.

The handheld advanced nucleic acid analyzer (HANAA) is a portable real time thermal cycler unit that weighs under 1 kg and uses silicon and platinum-based thermalcycler units to conduct rapid heating and cooling of plastic reaction tubes. Two light emitting diodes (LED) provide greater than 1 mW of electrical power at wavelengths of 490 nm (blue) and 525 nm (green), allowing detection of the dyes FAM and JOE/TAMRA. Results are displayed in real time as bar graphs, and up to three, 4-sample assays can be run on the charge of the 12 V portable battery pack. The HANAA was evaluated for detection of defined Escherichia coli strains, and wild-type colonies isolated from stream water, using PCR for the lac Z and Tir genes. PCR reactions using SYBR Green dye allowed detection of E. coli ATCC 11775 and E. coli O157:H7 cells in under 30 min of assay time; however, background fluorescence associated with dye binding to nonspecific PCR products was present. DNA extracted from three isolates of Bacillus anthracis Ames, linked to a bioterrorism incident in Washington DC in October 2001, were also successfully tested on the HANAA using primers for the vrrA and capA genes. Positive results were observed at 32 and 22 min of assay time, respectively. A TaqMan probe specific to the aroQ gene of Erwinia herbicola was tested on the HANAA and when 500 cells were used as template, positive results were observed after only 7 min of assay time. Background fluorescence associated with the use of the probe was negligible. The HANAA is unique in offering real time PCR in a handheld format suitable for field use; a commercial version of the instrument, offering six reaction chambers, is available as of Fall 2002.

Bacillus anthracis↗
PubMed2003

A field investigation of Bacillus anthracis contamination of U.S. Department of Agriculture and other Washington, D.C., buildings during the anthrax attack of October 2001.

In response to a bioterrorism attack in the Washington, D.C., area in October 2001, a mobile laboratory (ML) was set up in the city to conduct rapid molecular tests on environmental samples for the presence of Bacillus anthracis spores and to route samples for further culture analysis. The ML contained class I laminar-flow hoods, a portable autoclave, two portable real-time PCR devices (Ruggedized Advanced Pathogen Identification Device [RAPID]), and miscellaneous supplies and equipment to process samples. Envelopes and swab and air samples collected from 30 locations in the metropolitan area once every three days were subjected to visual examination and DNA extraction, followed by real-time PCR using freeze-dried, fluorescent-probe-based reagents. Surface swabs and air samples were also cultured for B. anthracis at the National Veterinary Service Laboratory (NVSL) in Ames, Iowa. From 24 October 2001 to 15 September 2002, 2,092 pieces of mail were examined, 405 real-time PCR assays were performed (comprising 4,639 samples), and at the NVSL 6,275 samples were subjected to over 18,000 platings. None of the PCR assays on DNA extracted from swab and air samples were positive, but viable spores were cultured from surface swabs taken from six locations in the metropolitan area in October, November, and December 2001 and February, March, and May 2002. DNA extracted from these suspected B. anthracis colonies was positive by real-time and conventional PCRs for the lethal factor, pXO1, and for capA and vrr genes; sequence analysis of the latter amplicons indicated >99% homology with the Ames, vollum, B6273-93, C93022281, and W-21 strains of B. anthracis, suggesting they arose from cross-contamination during the attack through the mail. The RAPID-based PCR analysis provided fast confirmation of suspect colonies from an overnight incubation on agar plates.

Anthrax↗