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Dive into the research topics where Marc A. Ellsworth is active.

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Featured researches published by Marc A. Ellsworth.


Pediatrics | 2015

Off-Label Use of Inhaled Nitric Oxide After Release of NIH Consensus Statement

Marc A. Ellsworth; Malinda N. Harris; William A. Carey; Alan R. Spitzer; Reese H. Clark

BACKGROUND: Inhaled nitric oxide (iNO) therapy is an off-label medication in infants <34 weeks’ gestational age. In 2011, the National Institutes of Health released a statement discouraging routine iNO use in premature infants. The objective of this study was to describe utilization patterns of iNO in American NICUs in the years surrounding the release of the National Institutes of Health statement. We hypothesized that iNO prescription rates in premature infants have remained unchanged since 2011. METHODS: The Pediatrix Medical Group Clinical Data Warehouse was queried for the years 2009–2013 to describe first exposure iNO use among all admitted neonates stratified by gestational age. RESULTS: Between 2009 and 2013, the rate of iNO utilization in 23- to 29-week neonates increased from 5.03% to 6.19%, a relative increase of 23% (confidence interval: 8%–40%; P = .003). Of all neonates who received iNO therapy in 2013, nearly half were <34 weeks’ gestation, with these infants accounting for more than half of all first exposure iNO days each year of the study period. CONCLUSIONS: The rates of off-label iNO use in preterm infants continue to rise despite evidence revealing no clear benefit in this population. This pattern of iNO prescription is not benign and comes with economic consequences.


Journal of the American Medical Informatics Association | 2017

An appraisal of published usability evaluations of electronic health records via systematic review.

Marc A. Ellsworth; Mikhail A. Dziadzko; John C. O'Horo; Ann M. Farrell; Jiajie Zhang; Vitaly Herasevich

Objective: In this systematic review, we aimed to evaluate methodological and reporting trends present in the current literature by investigating published usability studies of electronic health records (EHRs). Methods: A literature search was conducted for articles published through January 2015 using MEDLINE (Ovid), EMBASE, Scopus, and Web of Science, supplemented by citation and reference list reviews. Studies were included if they tested the usability of hospital and clinic EHR systems in the inpatient, outpatient, emergency department, or operating room setting. Results: A total of 4848 references were identified for title and abstract screening. Full text screening was performed for 197 articles, with 120 meeting the criteria for study inclusion. Conclusion: A review of the literature demonstrates a paucity of quality published studies describing scientifically valid and reproducible usability evaluations at various stages of EHR system development. A lack of formal and standardized reporting of EHR usability evaluation results is a major contributor to this knowledge gap, and efforts to improve this deficiency will be one step of moving the field of usability engineering forward.


Pediatrics | 2010

Infant Race Affects Application of Clinical Guidelines When Screening for Drugs of Abuse in Newborns

Marc A. Ellsworth; Timothy P. Stevens; Carl T. D'Angio

BACKGROUND: Screening for illicit drugs in newborns has privacy, social, and legal risks for families of the infants. Established drug-screening criteria may be applied in a manner that considers nonproven risk factors such as race in addition to evidence-based factors. OBJECTIVE: The goal of this study was to determine if race was used as a criterion for screening infants for intrauterine cocaine exposure. We hypothesized that infants of black mothers would be more likely to be screened regardless of whether they met the standard criteria for screening of our institutions NICU. METHODS: We used the electronic medical records of newborn infants and their mothers to determine which mother-infant pairs had documented evidence of meeting the criteria for screening infants for prenatal exposure to illicit drugs set forth in the guidelines of our NICU. We then assessed the rates of drug screening to determine the strongest predictors of whether an infant would be screened. RESULTS: We assessed 2121 mother-infant pairs. Infants born to black mothers were more likely than those born to white mothers to have screening performed whether they met screening criteria (35.1% vs 12.9%; P < .001) or did not (5.3% vs 1.2%; P < .001). In a logistic regression analysis, black race remained independently associated (odds ratio: 2.17 [95% confidence interval: 1.25–3.79]) with drug screening even when we controlled for our standard screening criteria and income, insurance status, and maternal education. CONCLUSION: Providers seemed to have used race, in addition to recognized risk criteria, as a factor in deciding whether to screen an infant for maternal illicit drug use.


BMC Medical Informatics and Decision Making | 2014

Clinical data needs in the neonatal intensive care unit electronic medical record

Marc A. Ellsworth; Tara R. Lang; Brian W. Pickering; Vitaly Herasevich

BackgroundThe amount of clinical information that providers encounter daily creates an environment for information overload and medical error. To create a more efficient EMR human-computer interface, we aimed to understand clinical information needs among NICU providers.MethodsA web-based survey to evaluate 98 data items was created and distributed to NICU providers. Participants were asked to rate the importance of each data item in helping them make routine clinical decisions in the NICU.ResultsThere were 23 responses (92% – response rate) with participants distributed among four clinical roles. The top 5 items with the highest mean score were daily weight, pH, pCO2, FiO2, and blood culture results. When compared by clinical role groupings, supervisory physicians gave individual data item ratings at the extremes of the scale when compared to providers more responsible for the daily clinical care of NICU patients.ConclusionNICU providers demonstrate a need for large amounts of EMR data to help guide clinical decision making with differences found when comparing by clinical role. When creating an EMR interface in the NICU there may be a need to offer options for varying degrees of viewable data densities depending on clinical role.


American Journal of Perinatology | 2013

Perceptions and practices of therapeutic hypothermia in American neonatal intensive care units.

Malinda N. Harris; William A. Carey; Marc A. Ellsworth; Lindsey R. Haas; Tyler K. Hartman; Tara R. Lang; Christopher E. Colby

OBJECTIVE In 2005, therapeutic hypothermia (TH) was used in few American neonatal intensive care units (NICUs) with great variability in practices. We hypothesized that TH would be used with greater frequency and uniformity today. STUDY DESIGN We surveyed directors of 797 NICUs queried in our prior study to determine attitudes toward and practices of TH. RESULTS Of the 781 participants with valid addresses, we received completed surveys from 330 (42.3%). There was an increase in the number of respondents who believed that TH is effective (85% versus 31%, p < 0.0001). More NICUs used TH (50% versus 6%, p < 0.0001) and nearly all not offering TH transferred eligible neonates to centers that did (97% versus 29%, p < 0.0001). There has been increased standardization of TH practices with regard to enrollment criteria, duration, and methods of monitoring. CONCLUSION TH has become standard of care for the treatment of HIE in the United States. Most NICUs that use TH adhere to protocols, but variation still exists in TH practices.


JAMA Pediatrics | 2016

Inhaled Nitric Oxide Use in the Neonatal Intensive Care Unit: Rising Costs and the Need for a New Research Paradigm

William A. Carey; Marc A. Ellsworth; Malinda N. Harris

For nearly 2 decades inhaled nitric oxide (iNO) has played an essential role in the management of severe hypoxic respiratory failure in term and late-preterm neonates. Selective vasodilation with iNO decreases ventilation-perfusion mismatch in the lung and thereby improves oxygenation in various forms of neonatal lung disease. Randomized clinical trials have demonstrated the safety and effectiveness of iNO as a treatment for persistent pulmonary hypertension of the newborn, with recipients less often requiring extracorporeal membrane oxygenation. Unfortunately, subgroup analyses in these studies have failed to demonstrate a benefit for neonates with congenital diaphragmatic hernia (CDH), congruent with that of an early clinical trial1 of iNO in this high-risk population. Premature neonates are another high-risk group for whom iNO provides no clear benefit. In this population neither routine use nor rescue treatment with iNO improves survival, nor does either strategy reduce the incidence of various morbidities or long-term neurodevelopmental impairment.2 The weight of the evidence in this regard is sufficiently strong that both the National Institutes of Health and the American Academy of Pediatrics have issued consensus opinions to guide the practice of American neonatologists. Still, even after publication of both reports, the use of iNO among the most premature neonates is on the rise.2 Over the same period of time a similar pattern of increasing iNO use has evolved among neonates with CDH.1 Based on current use and cost estimates,1,2 and given the recent rates of CDH and delivery at less than 34 weeks’ gestation,3 this nonevidence-based prescription of iNO may cost the American health system


Case reports in pediatrics | 2014

Acute liver failure secondary to niacin toxicity.

Marc A. Ellsworth; Katelyn R. Anderson; David J. Hall; Deborah K. Freese; Robin M. Lloyd

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Applied Clinical Informatics | 2015

Point-of-Care Knowledge-Based Resource Needs of Clinicians

Marc A. Ellsworth; J.M. Homan; James J. Cimino; Steve G. Peters; Brian W. Pickering; Vitaly Herasevich

236 million annually. At present, it is unclear why there exists such discordance between these 2 practice patterns and the evidence that is intended to inform them. Perhaps it is the case that some neonatologists, when facing these gravest of circumstances, initiate iNO therapy in an act of hopeful desperation—It’s better to try something than to do nothing, even if it is unlikely to work. Another possibility is that some neonatologists prescribe iNO on a case-by-case basis, bearing in mind that for certain subgroups of patients iNO may yield favorable outcomes.1,2 Indeed, there has been a gradual accumulation of evidence that iNO may improve oxygenation and confer long-term benefits to neonates affected by preterm premature rupture of membranes (PPROM)–associated pulmonary hypertension.2,4 The problem is that this aggregation of case series and cohort studies has been proffered as the best evidence neonatologists are likely to see.4 Without appropriately powered clinical trials to refine questions and provide clear answers, neonatologists will be left to continue to use their best clinical judgment when confronted with these and other challenging cases. The relatively low incidence of PPROM-associated pulmonary hypertension has been cited as an insurmountable barrier to the prospective study of iNO4 and, given the similar incidence of CDH,1,3 the same could be said for this diagnosis. However, it is important to note that these perceived barriers exist within the context of the present-day system of neonatal research. Perhaps now is the time for a different approach to the study of those disorders that burden neonatologists with unknowns and the American health care system with substantial costs. One path forward may have been paved by our colleagues in pediatric oncology. The Children’s Oncology Group (COG) is a collaborative research organization that today includes more than 200 pediatric medical centers in North America, Europe, and Australasia.5 The COG traces its roots to the first pediatric cancer cooperative study group, a collaborative of just 8 centers, in 1955. Other disease-specific study groups were formed in the following years, each leading to advances in the treatment of various forms of pediatric cancer. Over the next few decades, it was increasingly recognized that the relatively low incidence of childhood cancer and the growing number of patient subgroups required an even more collaborative approach. Thus, in 2000 the 4 leading clinical trials groups merged to form the COG and establish modern-day cancer treatment for children around the world. Today, more than 90 percent of all American children with newly diagnosed cancer are evaluated at a COG center.5 More than half of these patients are enrolled in a COG clinical trial if one is available, enabling more than 4000 children to receive the latest in evidence-based care each year. This large-scale, collaborative approach to clinical research is especially important for those children whose cancer subtypes are relatively rare and associated with low event-free VIEWPOINT


Applied Clinical Informatics | 2014

Information needs for the OR and PACU electronic medical record

Vitaly Herasevich; Marc A. Ellsworth; J. R. Hebl; M. J. Brown; Brian W. Pickering

A 17-year-old male was transferred to the pediatric intensive care unit for evaluation of acute liver failure. He was recently released from an alcohol treatment center with acute onset of chest pain. Cardiac workup was negative but he was found to have abnormal coagulation studies and elevated liver transaminases. Other evaluations included a normal toxicology screen and negative acetaminophen level. Autoimmune and infectious workups were normal providing no identifiable cause of his acute liver failure. He initially denied any ingestions or illicit drug use but on further query he admitted taking niacin in an attempt to obscure the results of an upcoming drug test. Niacin has been touted on the Internet as an aid to help pass urine drug tests though there is no evidence to support this practice. Niacin toxicity has been associated with serious multisystem organ failure and fulminant hepatic failure requiring liver transplantation. Pediatric providers should be aware of the risks associated with niacin toxicity and other experimental medical therapies that may be described on the Internet or other nonreputable sources.


American Journal of Perinatology | 2016

Does Red Blood Cell Transfusion-Related Acute Lung Injury Occur in Premature Infants? A Retrospective Cohort Analysis

Jacquelyn E. M. Grev; Marketa Stanclova; Marc A. Ellsworth; Christopher E. Colby

OBJECTIVE To better understand the literature searching preferences of clinical providers we conducted an institution-wide survey assessing the most preferred knowledge searching techniques. MATERIALS AND METHODS A survey regarding literature searching preferences was sent to 1862 unique clinical providers throughout Mayo Clinic. The survey consisted of 25 items asking respondents to select which clinical scenarios most often prompt literature searches as well as identify their most preferred knowledge resources. RESULTS A total of 450 completed surveys were returned and analyzed (24% response rate). 48% of respondents perform literature searches for more than half of their patient interactions with 91% of all searches occurring either before or within 3 hours of the patient interaction. When a search is performed 57% of respondents prefer synthesized information sources as compared to only 13% who prefer original research. 82% of knowledge searches are performed on a workstation or office computer while just 10% occur on a mobile device or at home. CONCLUSION Providers in our survey demonstrate a need to answer clinical questions on a regular basis, especially in the diagnosis and therapy domains. Responses suggest that most of these searches occur using synthesized knowledge sources in the patient care setting within a very short time from the patient interaction.BACKGROUND Two years ago, the Diabetic Retinopathy (DRP) and Traumatology clinic of the Department of Ophthalmology and Optometrics at the Medical University of Vienna, Austria switched from paper-based to electronic health records. A customized electronic health record system (EHR-S) was implemented. OBJECTIVES To assess the completeness of information documented electronically compared with manually during patient visits. METHODS The Preferred Practice Pattern for Diabetic Retinopathy published by the American Academy of Ophthalmology was distilled into a list of medical features grouped into categories to be assessed and documented during the management of patients with DRP. The last seventy paper-based records and all electronic records generated since the switch were analyzed and graded for the presence of features on the list and the resulting scores compared. RESULTS In all categories, clinical documentation was more complete in the EHR group. CONCLUSIONS In our setting, the implementation of an EHR-S showed a statistically significant positive impact on documentation completeness.

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