Pediatric clinics of North America
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Climate change is increasing the burden of climate-sensitive health determinants and outcomes worldwide. Acting through increasing temperature, changes in the hydrologic cycle, and sea level rise, climate change is projected to increase the frequency and intensity of heat events and extreme events (floods and droughts), change the geographic range and incidence of climate-sensitive vector-, food-, and waterborne diseases, and increase diseases associated with air pollution and aeroallergens. Children are particularly vulnerable to these health outcomes because of their potentially greater exposures, greater sensitivity to certain exposures, and their dependence on caregivers.
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The rural environment is not as wholesome as some might think. In fact, smoking, drinking, illicit drug use, and obesity are more prevalent in rural than in urban youngsters. ⋯ Air and water quality are monitored less and actually may be worse in the country than in urban areas. This article describes children's health problems associated with the rural environment and provides a list of resources for addressing these problems.
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Currently, the only national databases that are available to aid in a search to assess the effect of environmental exposures on children's health are those provided by the Pediatric Environmental Health Specialty Units and poison control centers. Both have limitations and are largely deficient in accurate, helpful numbers. Both, however, offer insight into factors that are important to the public and health care professionals and provide some outcome data to measure morbidity and mortality. This article presents an analysis of the information in these databases about children's exposure to toxic environmental substances.
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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. ⋯ 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.
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Pediatr. Clin. North Am. · Dec 2006
ReviewTailoring the Institute for Health Care Improvement 100,000 Lives Campaign to pediatric settings: the example of ventilator-associated pneumonia.
In December 2004, the Institute for Healthcare Improvement launched a campaign to save 100,000 lives by implementing evidence-based interventions in six areas, five of which are relevant to children. Working collaboratively, the Child Health Corporation of America, National Associate of Children's Hospitals and Related Institutions, and National Initiative for Children's Health Care Quality provided a series of Web-enabled seminars on how the campaign initiatives might be adapted for pediatric settings. Ventilator-associated pneumonia (VAP) is an example of how interventions based on evidence in adult settings may need to be tailored in pediatric settings. The authors describe how assessing and implementing parts of the VAP bundle led to reduction in VAP in two children's hospitals.