Exploring racial differences in IgE-mediated food allergy in the WHEALS birth cohort.

Background: Suspected food allergies are the cause of more than 200,000 visits to the emergency department annually. Racial differences in the prevalence of food allergy have also been reported, but the evidence is less conclusive. Researchers continue to struggle with the identification of food allergy for epidemiologic studies.

Transforming growth factor beta (TGFβ1) in breast milk and indicators of infant atopy in a birth cohort.

Background: The infant gut's ability to suppress immunologic reactions to food proteins could be influenced by levels of TGFβ in breast milk. We hypothesized that lower levels of TGFβ(1) in the breast milk (BM) of mothers in the WHEALS birth cohort are associated with atopy at infant age 2-3 yrs.

Methods: We used data collected during infancy in addition to the results of skin prick tests (SPT+) and measures of specific IgE >0.

Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts.

Background: A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis.

A cluster-randomized trial to provide clinicians inhaled corticosteroid adherence information for their patients with asthma.

Background: Inhaled corticosteroid (ICS) nonadherence is common among patients with asthma; however, interventions to improve adherence have often been complex and not easily applied to large patient populations.

Objective: To assess the effect of supplying patient adherence information to primary care providers.

Methods: Patients and providers were members of a health system serving southeast Michigan.

The morningside initiative: collaborative development of a knowledge repository to accelerate adoption of clinical decision support.

The Morningside Initiative is a public-private activity that has evolved from an August, 2007, meeting at the Morningside Inn, in Frederick, MD, sponsored by the Telemedicine and Advanced Technology Research Center (TATRC) of the US Army Medical Research Materiel Command. Participants were subject matter experts in clinical decision support (CDS) and included representatives from the Department of Defense, Veterans Health Administration, Kaiser Permanente, Partners Healthcare System, Henry Ford Health System, Arizona State University, and the American Medical Informatics Association (AMIA). The Morningside Initiative was convened in response to the AMIA Roadmap for National Action on Clinical Decision Support and on the basis of other considerations and experiences of the participants.

Improving the documentation of vital signs: a business reengineering efficiency study.

By upgrading its electronic medical record to include a Quick Vitals screen, the Henry Ford Health System increased the mean rate of entry of vital signs from 0.7% to 58.5%.

An assessment of user acceptance and satisfaction with the tobacco use cessation automated clinical practice guideline.

Objective: To describe user acceptance of and satisfaction with the Tobacco Use Cessation (TUC) Automated Clinical Practice Guideline (ACPG) at the Henry Ford Health System.

Study Design: A previous investigation assessed compliance with the 5 As (ask, advise, assess, assist, and arrange) of the TUC ACPG across 3 study arms. This article describes user satisfaction with the TUC ACPG after implementation.

Implementation of an obstetrics EMR module: overcoming user dissatisfaction.

To improve quality and efficiency, Henry Ford Health System developed and implemented a new obstetrics application that displays pertinent clinical practice guideline information and standardizes documentation. The initial application included an overview of the patient's vital sign history, a structured note appropriate for each visit and patient educational materials. Despite involvement by clinician subject-matter experts in its design, many clinicians were dissatisfied with the initial application, noting both performance and functionality issues.

Race-ethnicity, crime, and other factors associated with adherence to inhaled corticosteroids.

Background: Previous studies have shown differences in adherence to inhaled corticosteroids (ICSs) by race-ethnicity, yet little is known about factors that contribute to adherence within these groups. Environmental stressors, such as crime exposure, which has been associated with asthma morbidity, might also predict ICS adherence.

Objective: We sought to identify factors associated with ICS adherence among patients with asthma and among African American patients and white patients separately.

Effects of the tobacco use cessation automated clinical practice guideline.

Objective: To evaluate the effects of the Tobacco Use Cessation (TUC) Automated Clinical Practice Guideline (ACPG) (a variation of the US Department of Health and Human Services Clinical Practice Guideline on Treating Tobacco Use and Dependence) on guideline adherence in a multisite health system.

Study Design: The study used a pre-post cross-sectional design. Paneled patients were enrolled from 6 clinics, including 2 control clinics (arm 1), 2 control clinics that received a check-in screen only (the check-in screen provided a simplified method for entering patient vital signs into the electronic medical record) (arm 2), and 2 clinics that received the TUC intervention (arm 3).

Health effects of written emotional disclosure in adolescents with asthma: a randomized, controlled trial.

Objective: To test the effects of written emotional disclosure on the health of adolescents with asthma and to examine how language in disclosures predicts outcomes.

Methods: We randomized 50 adolescents with asthma to write for 3 days at home about stressful events (disclosure) or control topics. At baseline and 2 months after writing, we assessed symptoms, affect, disability, internalizing behavior problems, and lung function; parents independently rated internalizing behavior and disability.