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Introduction: The Electronic Health Record (EHR) is being advocated as a tool to improve patient care. Nationwide initiatives are under way to determine how to implement EHR. To date, community nursing homes have not been involved in that effort. Many reasons, including multiple providers in a home, physical structure of a facility, multiple facilities, high costs of implementation, and maintenance of an EHR, hinder efforts to establish such a record in a nursing home. Convinced that an EHR would improve resident care, we undertook a project to establish an EHR in 11 community nursing homes. Methods: Boston University Geriatric Services and Boston Medical Center partnered with 11 community nursing homes in the Boston, MA, area to introduce GE Centricity as the medical provider’s medical recordfor the residents under the care of this medical practice. This effort included allowing the software to be used at various sites, providing hardware, and establishing Internet connectivity. Results: All 11 of the nursing homes served by Boston University Geriatric Services have been connected to the system. Discussion: It is possible to establish an EHR in a diverse, unrelated group of nursing homes. This has allowed for improved communication between providers, consultants, hospital, and nursing home staff. [Copyright &y& Elsevier]

Objective: To determine whether, in infants with a tongue-tie and a feeding problem, the current medical treatment (referral to a lactation consultant) or immediate division works best and enables the infants to feed normally.Methods: Between March and July 2002, all the babies in the district of Southampton with tongue-ties were followed in order to see if they had any feeding problems. If they developed problems, the mothers gave written consent and were enrolled in an ethics committee approved, randomized, controlled trial, comparing 48 h of intensive lactation consultant support (control) with immediate division.Results: A total of 201 babies had tongue-tie, of whom 88 had breast-feeding or bottle-feeding problems. Thirty-one were not enrolled, so 57 were randomized. Of the 29 controls, one improved (3%) and breast-fed for 8 months, but 28 did not. At 48 h, these 28 were offered division, which all accepted, and 27 improved (96%) and fed normally. Of the 28 babies who had immediate division, 27 improved and fed normally but one remained on a nipple shield (P < 0.001). Twenty-four mothers breast-fed for 4 months (24/40, 60%). Overall, division of the tongue-tie babies resulted in improved feeding in 54/57 (95%) babies.Conclusions: This randomized, controlled trial has clearly shown that tongue-ties can affect feeding and that division is safe, successful and improved feeding for mother and baby significantly better than the intensive skilled support of a lactation consultant. [ABSTRACT FROM AUTHOR]