KeywordsComputer provider order entry, clinical decision support, electronic medical record Summary Background: Many resident physicians have experienced transitioning from traditional paper documentation and ordering to an electronic process during their training. Objective: We sought to investigate the attitudes and perceptions of residents related to implementation of computer provider order entry (CPOE) and clinical decision support (CDS). Methods: Pediatric residents completed web-based surveys prior to CPOE implementation and at 6 months and 12 months after implementation. The survey assessed resident attitudes and perceptions related to CPOE and the use of CDS tools. Additionally, at 6 and 12 months, residents were asked how electronic medical record (EMR) resources might impact future career decisions. Results: Prior to CPOE implementation, 70% of residents were looking forward to CPOE, but 28% did not want to transition from paper ordering. At 12 months post-implementation, 80% of residents favored CPOE over paper ordering and only 3.33% wished to revert to paper ordering. Residents reported an increase in time needed to enter admission orders 6-months after CPOE implementation. By 12 months post-implementation, there was no significant difference in perceived time to complete admission orders when compared to pre-CPOE responses. Most residents (91.67%) identified that overall EMR resources were an important factor when considering future employment opportunities. The most important factors included the degree of EMR implementation, technology resources and the amount of support staff. The least important factors included patient portal access and which EMR product is used. Conclusions: Overall, residents demonstrated a preference for CPOE compared to traditional paper order entry. Many residents remained unaware of CDS tools embedded within CPOE at the 12 month follow-up, but a majority of residents did find them helpful and felt more knowledgeable about current guidelines. EMR resources, including degree of EMR implementation, technology resources and support staff are likely to be important factors as residents take future employment opportunities into consideration.
Cellulitis and other skin and soft tissue infections are a common reason for children to seek care, both in the primary care setting and the emergency department. Cellulitis is a common skin and soft-tissue infection that is usually caused by streptococci bacteria or, less commonly, Staphylococcus aureus . Most children recover quickly from cellulitis, but a small subset will require hospitalization. Practitioners need to be skilled in the diagnosis and treatment of cellulitis, including recognition of the need for inpatient treatment. However, diagnosis of cellulitis, and exclusion of complicated or other more serious infections, can be challenging. Management of these infections has also been highly variable, resulting in some difficulty identifying the ideal treatment regimen. The goal is to use the antibiotic with the narrowest spectrum for the shortest duration necessary to provide clinical improvement. Research to identify the best treatment for pediatric cellulitis will be important moving forward. [ Pediatr Ann . 2017;46(7):e265–e269.]
Coronavirus Disease 2019 is the most devastating pandemic of this century. Little is known about the impact of COVID-19 on children, especially those with underlying conditions. We describe the case of a 4-year-old with hereditary spherocytosis who was found to be positive for COVID-19 and secondary hemolytic anemia. With supportive care and transfusions, he clinically improved, and his hemoglobin stabilized. This case reminds us to remain vigilant in evaluating high risk patients for hemolysis in the face of infection. Further studies on the clinical presentation and trajectory of patients presenting with COVID-19 and underlying disease should be encouraged.
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